Indigenous communities at risk of antimicrobial resistance

Pharmacists say a new approach is needed to treat the high rates of bacterial infections among remote Indigenous communities after a new study suggested high antibiotic prescribing rates could increase the risk of antimicrobial resistance.

Bowen et al examined a range of evidence looking at the impact of antibiotic use in remote Indigenous communities. They found that rates of methicillin resistant Staphylococcus aureus in remote northern Indigenous Australian communities were approximately 50%.¹ In an interview with the ABC, Associate Professor Steven Tong from the Doherty Institute for Infectious Diseases noted that this is significantly higher than the resistance rates of the rest of the country, which are at around 15%.

The burden of bacterial infections on Indigenous communities is well documented. Cuningham et al examined three separate cohorts of Indigenous children from five remote communities in the Northern Territory’s East Arnhem over a three year period and found that 96% of the study population (n = 355) experienced upper respiratory tract infections and 86% contracted skin sores.²

Consequently, antibiotic prescription rates are high amongst children in these communities. All of the children in the study were prescribed at least one prescription in their first year of life, and almost half were prescribed six antibiotics before turning one.²

These numbers are high by international standards. Cuningham et al noted that a US study demonstrated lower rates of antibiotic exposure where only 35% of children had been exposed to antibiotics in the first sixth months of life.²

Reducing the risk of resistance

Speaking to Australian Pharmacist, Sam Keitaanpaa, a Clinical Service Specialist Pharmacist in the Northern Territory, urged pharmacists in rural areas to educate their patients about taking antimicrobials in a way that ‘reduces the risk of resistance’.

Mr Keitaanpaa said this includes discussing the importance of completing antibiotic courses with patients, and also encouraged pharmacists to refer patients back to prescribers when they believe they have been prescribed inappropriately. He noted that he often sees cases where people mistake the presence of pus for infection.

‘Making sure that everyone is very clinically up to date is important. There are cases where antibiotics are really not warranted, and I think we really do have a professional duty to raise our concerns as health professionals about the use of those agents,’ he said.

Long term solutions

Mr Keitaanpaa also pointed out that reducing bacterial infections amongst Indigenous children, particularly skin sores, is imperative to reducing antimicrobial use in the long term.

He encouraged pharmacists to discuss skin hygiene with their patients, as well as wound care to reduce the risk of infection.

However, he also noted that structural reform and more research is necessary to reduce rates of bacterial infection in Indigenous communities, and pointed out that greater data collection could provide more information about the way antimicrobials are being used.

‘Many of these antibiotics are provided without a clear indication being recorded in clinical software, so we just don’t really know what they’re being used for. It’s therefore hard to understand prescribing patterns and develop targeted interventions. I think there’s a massive opportunity to improve pharmacist level surveillance,’ he said.

Researchers said data about the use of antimicrobials in Indigenous communities is particularly sparse, given that antimicrobials supplied by Aboriginal and Torres Strait Islander health services are generally not captured under the Pharmaceutical Benefits Scheme.¹

Meanwhile, Mr Keitaanpaa also noted that a greater understanding of cultural norms within different communities, including a reluctance to complete courses of antibiotics, could increase health outcomes.

Cuningham et al also acknowledged that ‘ultimately, reductions in antibiotic use will only occur with reductions in the prevalence of infections’.

‘Notably, where successes have occurred in reducing prevalence of skin infections, the programs involved whole-of-community engagement with a broader focus on community participation in “healthy skin days”, rather than just screening and treating of individuals with skin infections.’²