ESA-Antibiotic Resistance, Guidelines and Stewardship (#24)
Sixty Years ago, antibiotics were hailed as miracle drugs. No other medical discovery has saved more lives in that time. In recent years, the miracle has been seriously threatened and the rise of resistance has meant that many of the advances in modern medicine may become seriously compromised. The WHO has listed the rise of resistance as one of the 3 greatest threats to human health. This has been compounded by the marked decline in new antibiotics entering the pipeline, with fewer than 10 being registered over the last decade. Infections with antibiotic resistant bacteria used to be thought to be a part of hospital practice, but are now widespread in the community. About 25% of severe Staph aureus infections from the community are MRSA, and multi drug resistant Gram negatives such as E coli and Klebsiella are not uncommon. The solution to this problem is not obvious. Increased efforts towards new drug discovery are being made and in Australia, the NH&MRC has reprioritised research on infections and resistance. Maintaining the utility of our current antibiotic armamentarium is a priority, and this means reducing the selective pressure of antibiotics in general. Ensuring that only those who truly need antimicrobial therapy get it, and that narrow spectrum antibiotics are used whenever possible has led to the development of antibiotic stewardship programs which will be a mandatory part of accreditation of all healthcare facilities in Australia. Essential components of stewardship programs include guidelines, formularies and restrictions, audit and feedback. Every specialty has been asked to include antibiotic prescribing and the principles of antibiotic stewardship in their curriculum. This strategy is hoped to contribute to prolonging the utility of current agents to allow time for new strategies such as vaccines and new agents to be developed.