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Medical microbiologists and infectious disease physicians have long warned that excessive and inappropriate use of antibiotics is a major selection factor for antibiotic-resistant microorganisms. In addition, the development of new antimicrobial agents has slowed. There is a real risk of running out of antibiotics. In June this year, the World Health Organization reinforced earlier calls to action with a report titled, Overcoming Antimicrobial Resistance.
The first part of this lecture reviews the history of antibiotic resistance, presents current data from Australia and other countries and discusses the consequences of increasing resistance, the social factors that fuel the process and how resistance might be slowed.
The second part of the lecture focuses on the Australian response to antibiotic resistance. Over a 20-year period, initiatives that started at one University Teaching Hospital have now been incorporated into national medicinal drug policy. The Australian government has provided funds to implement strategies designed to improve antibiotic and other drug use. One strategy was to develop partnership and shared recognition of the problem between the key groups involved: government, industry, health professionals and consumers. Another was to support the development of independent therapeutic guidelines and drug information resources and encourage more ethical pharmaceutical promotion. Another important strategy was medication review; comparing what was prescribed and consumed with what was recommended and, where discrepancies were found, encouraging reflection and remedial action. Education campaigns were also developed for both the public and for health professionals while professional capacity was built by encouraging targeted research and education. The main mechanism for implementation was a competitive grant and scholarship program costing around A$4.0 million per annum.
These strategies have been remarkably successful. The prescribing habits of both private and public sector physicians have improved. Antibiotic use in Australia peaked in the early 1990's and has been slowly declining ever since.
The current challenge is to use information technology to further improving prescribing practice. Computer assisted prescribing has the potential to integrate best-practice guidelines with the emerging electronic medical record and gently prompt physicians about drugs of choice and potential problems such as dosage errors and drug-drug interactions. In addition, hospital networks and Internet connectivity have the potential of linking doctors, pharmacists, and ultimately consumers, into a mutually supporting network that could further facilitate best practice.