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THE New South Wales Health Minister’s decision to authorise funding for a 12-month trial to allow pharmacists to prescribe medication for urinary tract infections, and other conditions, “flies in the face” of concerns about antimicrobial resistance, says the vice-president of the Australian Medical Association (AMA).
Speaking before the launch last Friday of a new AMA report – Antimicrobial resistance: the silent global pandemic – Dr Danielle McMullen said the NSW decision was incredibly problematic.
“To allow patients to walk into a pharmacy and then walk out with a box of antibiotics flies in the face of high quality antimicrobial stewardship,” she told InSight+.
According to the AMA report, antimicrobial resistance is “considered by many as the silent global pandemic that will undermine healthcare systems and food safety and supply, and result in millions of deaths”.
Australian hospitals, according to Wozniak and colleagues, spent an “additional AUD$5.8 million per year treating ceftriaxone-resistant [Escherichia coli] bloodstream infections, and an estimated AUD$5.5 million per year treating [methicillin-resistant Staphylococcus aureus] patients”.
Australia lags behind in several key areas, according to the AMA, “including public awareness and understanding of antimicrobial resistance; stewardship; coordination and incentives for research and development; and national One Health governance”.
“There’s a lot more to antimicrobial resistance than doctors overprescribing antibiotics,” said Dr McMullen.
“We’re not shying away from that aspect of it, but this a multifactorial problem, needing all-of-system solutions involving human health, animal health, climate change.”
The AMA proposes three solutions in their report:
- “establishing a Centre for Disease Control (CDC) that is a recognised separate authority for the national scientific leadership and coordination of diseases and health threats, as well as several immediate priorities for government to ensure Australia’s response to antimicrobial resistance is effective, integrated, and aligned to One Health objectives;
- “improving antimicrobial stewardship practices in Australia, by embedding stewardship practices, education and training, and clinical decision support tools into all sectors;
- “improving the antimicrobial market through sovereign manufacturing of antimicrobials and implementing mechanisms to incentivise research and development.”
Sovereign manufacturing, Dr McMullen told InSight+, was a key factor in the current environment of supply chain interruptions and medication shortages.
“I recently had to prescribe a much broader antibiotic than I wanted to for a patient because the one I initially wanted was not on the pharmacy shelves,” said Dr McMullen, a practising GP.
“That’s a common problem at the moment, but if we are manufacturing our own medications then we can alleviate that.
“Beyond supply, it’s also about research and development, and slowing the brain drain – keeping our researchers in-country, providing them with career progression.”
GPs, as ever, are on the frontline of the battle against antimicrobial resistance, dealing with patients’ expectations about being prescribed antibiotics inappropriately.
“That conversation with patients is difficult,” said Dr McMullen.
“It takes longer to say no to a patient, and explain why, than it does to write a script.
“It’s part of our role as GPs to be good stewards and to provide best practice.
“The AMA and other groups are working on finding broad solutions to provide GPs with better resources and better funding to help them have those conversations.”
Australia has a National Centre for Antimicrobial Stewardship. Why do we need a national CDC to help with stewardship?
“A CDC would have a broader remit,” said Dr McMullen. “It would encourage that One Health system view and make it easier to apply antimicrobial resistance strategies across all policy areas.”
Government interest in increasing awareness in antimicrobial resistance varies from state to state, Dr McMullen said.
“Federally, there is interest in changing and improving support for GPs, and this certainly feeds into that advocacy.”
As in coronavirus disease 2019 (COVID-19) vaccine sharing and climate change, Australia has a responsibility as a global citizen to help less economically advanced countries to manage antimicrobial resistance.
“We will face many of the same challenges as we have in those areas,” said Dr McMullen.
“Hopefully, by highlighting the risks, not just to human health but also to food security, we can encourage our own government and those of other rich nations to be good global citizens.”
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Pharmacists in Australia are already allowed to sell chloramphenicol eyedrops over-the-counter. This has been happening for years, despite the fact that we as physicians, are pointed at as inappropriately over prescribing antibiotics. Therefore, every person with a red eye gets chloramphenicol drops. This is entirely inappropriate as most red eyes are NOT bacterial conjunctivitis.
I support AMS and see pharmacists as our key ally. However, what is the evidence that we doctors ‘do’ AMS? How much is AMS efforts within hospitals about antibiotics ‘starts’ [Sepsis initiative] versus antibiotic ‘stops’?