Home' Australian Pharmacist : Australian Pharmacist June 2012 Contents 456 Australian Pharmacist June 2012 I ©Pharmaceutical Society of Australia Ltd.
• While MRSA (or golden staph) was once
thought to be a problem con ned to
hospitals and aged care facilities, MRSA
now reaches much wider than that,
with experts saying around 25% of all
MRSA infections are now acquired in
the community setting.
• Of more concern, over the 10 years
from 2001--10, the incidence of MRSA in
the Australian community has doubled
from 10 to over 20% of all reported
• In Australia antibiotic use is also
contributing to the global e ect;
new strains of resistant bacteria have
emerged here for both staphylococcus
aureus and neisseria meningitidis
(the cause of meningococcal
meningitis). The multidrug resistant
tuberculosis crisis in Papua New
Guinea is already a ecting North
Queensland, and the incidence of
vancomycin-resistant enterococci --
rst detected in Australian hospitals in
1994, has gone from zero to over 30%.5
• Looking further a eld, every year in
the European Union (EU) it is estimated
that over 25,000 people die of
antibiotic-resistant bacterial infections,
mostly acquired in hospitals.
• The estimated total cost to society
of antibiotic resistance in the EU
alone is estimated to be €1.5 billion
• Longer durations of illness and more
complex treatment increase health care
costs and hence the nancial burden
on families and societies. We need to
ask ourselves what is the cost if we do
not address this issue in Australia?
• So what has led us to this point?
An expensive error
The overuse and misuse of antibiotics
globally is an error in judgment for which
we may pay dearly.
Our complacency in the way we use these
medicines has led to overuse, with little
consideration given to the impact they
may be having on an individual's health,
that of the population, or indeed the
health of future generations.
Australians are among some of the
highest users of antibiotics in the
developed world. Around 22 million
prescriptions are dispensed every year --
that is a script for every man, woman and
child in Australia each year.
We sit well above the OECD average in
terms of antibiotics used per capita/
per day. In fact, our usage is more than
double that of the Scandinavian countries
where antibiotic use is less socially
desirable -- and where health outcomes
appear to be no worse than countries
with high antibiotic usage.
Every year antibiotics are unnecessarily
prescribed for conditions where they
have no or limited impact - for viral
illnesses where antibiotics have no e ect,
and for simple bacterial infections where
our own immune system could easily
ght the infection without needing help
So who is responsible? Is it doctors?
After all, they write the prescriptions.
It is fair to say doctors do play their part
by providing unnecessary scripts in some
instances. Most antibiotic prescribing
in Australia occurs without scrutiny.
Our system is lacking in its ability to
track antibiotic usage in an e ective way,
and to provide feedback to doctors on
their prescribing decisions. There is also
insu cient information, such as local
resistance patterns, to help doctors make
informed treatment decisions. And it is
true that prescribers are often responding
to patient expectations and demand.
So is it patients then? Do they need to
stop asking? It turns out we're not shy
when it comes to asking for antibiotics.
Recent NPS research found that many
Australians go to their doctor expecting
to be prescribed antibiotics. In fact,
one in ve of those surveyed said they
expected their GP to prescribe antibiotics
for themselves or their child for a cough
or cold. When asked if they expect to be
prescribed antibiotics for an ear, nose,
throat or chest infection, this number
jumped to almost four in ve (79%), with
many consumers failing to realise that
these infections are also largely caused
Parents were twice as likely (14% vs 6%)
to request antibiotics to treat their child's
cold or cough as opposed to themselves,
with fathers more likely to ask than mothers
(22% vs 9%).
For many doctors, when a patient walks
through their surgery doors with an
expectation or request for antibiotics, it can
be hard to say no. With waiting rooms often
overcrowded, particularly during cold
and u season, a patient demanding or
expecting antibiotics will often leave with a
script -- just in case.
But why is this a problem?
The fact is, every time we use antibiotics
incorrectly or inappropriately,
we encourage the development of
antibiotic resistant bacteria. These are
bacteria which have, over time, changed
their DNA to withstand an assault
While the community is starting to
understand that the widespread use
of antibiotics can cause resistance at a
population level, what is not appreciated
is that individuals prescribed an antibiotic
are twice as likely to develop bacterial
resistance to that drug within their
This e ect may persist for up to
12 months.7,8 What is even more alarming is
that once we carry these resistant bacteria,
we can pass them to others including
those who may be more vulnerable than
ourselves. This is signi cant because it
introduces an element of individual harm
and also individual responsibility that has
been largely unappreciated.
If we continue our behaviours unchecked,
we do risk returning to an era like I
described in World War I -- where infections
from something as simple as a scratch have
the potential to kill. We are fast approaching
a situation where by the time our children
have become adults, we may have run out
of e ective antibiotics.
But is it just our past coming back to
haunt us, or have we created an even
The overuse and misuse
of antibiotics globally
is an error in judgment
for which we may pay
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