What is antibiotic resistance?
Antibiotic resistance occurs when bacteria change in response to the use of antibiotics and resist their effects. Like any other bacteria, resistant bacteria can be transmitted between people in close proximity such as family and household members and can cause severe infections.
Antibiotic resistance currently causes 30,000 avoidable deaths per year in Europe and the USA, and will overtake cancer in 2050. It threatens elective surgery, and foreshadows a resurgence of the bacterial diseases of the 19th century, with primary care becoming a major contributor to the problem.
In November 2018, we were awarded a $2.5M Centre of Research Excellence in Minimising Antibiotic Resistance in the Community (CRE-MARC) to translate and extend this work in 5 Research Streams: (1&2) translation and uptake of our previous studies in Acute Respiratory Infections; 3) extend our scope to urinary tract infections, skin infections; 4) Aged Care Facilities.
Three major obstacles remain to reducing antibiotic use in Australian primary care:
- the poor adoption of several effective interventions for improving ARI prescribing, which emphasises that the next steps should be implementation research focussed on improving uptake of these interventions into practice;
- the need to broaden the focus beyond minimising antibiotic use in just acute respiratory infections (ARIs) and to include the two other major antibiotic indications in primary care – skin and soft-tissue infections (SSTIs) and urinary tract infections (UTIs); and
- the well-known, but little understood, problem of very high use of antibiotics in Residential Aged Care Facilities (RACFs).
Our previous NHMRC CRE in Minimising Antibiotic Resistance for Acute Respiratory Infections (ARI) - CREMARA 2012-18, generated new knowledge about ARIs and antibiotic use in general practice.
Our research focussed on five main areas:
- Benefits and harms of antibiotics: updated reviews of benefits and new systematic reviews of harms will be done to correct the insufficient focus on harms which has distorted clinicians’ and patients’ benefits-harms judgement.
- Physical barriers: key elements of effective physical barrier interventions will be analysed in a meta-regression.
- Pharmaceutical packaging of antibiotics: we will research current packaging effects and community behaviours contributing to antibiotic resistance.
- Construction and validation of a causal model to determine relative contributions of each source of resistance and potential effect of each intervention. This will be informed by research in Areas 1-3 and epidemiological data.
- Development and evaluation of interventions to minimise antibiotic resistance: numerous innovative interventions, informed by research in Areas 1-4, and aimed at clinicians, patients, policy-makers and other key stakeholders, will be developed and evaluated.
- Del Mar, C.B., Scott, A.M., Glasziou, P.P., Hoffmann, T., van Driel, M.L., Beller, E., Phillips, S.M., Dartnell, J., 2017. Reducing antibiotic prescribing in Australian general practice: time for a national strategy. Med J Aust, 207(9), 401-406. Result of the 2017 Roundtable. Overviews the importance of addressing the antibiotic resistance crisis in general practice and outlines strategies and interventions that should be used to reduce antibiotic use in Australian general practice.
- Bakhit, M., Hoffmann, T., Scott, A.M., Beller, E., Rathbone, J., Del Mar, C., 2018. Resistance decay in individuals after antibiotic exposure in primary care: a systematic review and meta-analysis. BMC medicine, 16(1), 126. A review of evidence about the development and decay of antibiotic resistance in patients after antibiotic use.
- Scott, A.M., Beller, E., Glasziou, P., Clark, J., Ranakusuma, R.W., Byambasuren, O., Bakhit, M., Page, S.W., Trott, D. and Del Mar, C., 2018. Is antimicrobial administration to food animals a direct threat to human health? A rapid systematic review. International journal of antimicrobial agents, 52(3), 316-323. A systematic review commissioned by the World Health Organisation, to underpin the WHO guideline on the use of antibiotics in food animals.
- Hansen, M.P., Scott, A.M., McCullough, A., Thorning, S., Aronson, J.K., Beller, E.M., Glasziou, P.P., Hoffmann, T.C., Clark, J., Del Mar, C.B., 2019. Adverse events in people taking macrolide antibiotics versus placebo for any indication. Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD011825. Macrolide antibiotics are commonly prescribed for both acute and chronic infections, but the extent of adverse events was not clear. The review quantified adverse events in patients taking macrolide antibiotics, to assist clinicians and patients to balance the benefits and the risks of taking them.
- Coxeter, P., Del Mar, C.B., McGregor, L., Beller, E.M. and Hoffmann, T.C., 2015. Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. Cochrane Database of Systematic Reviews, Issue 11, Art. No.: CD010907. The review found that shared decision making interventions reduce antibiotic prescribing in primary care.