Antimicrobial resistance (AMR) in children is growing in remote Indigenous communities, reports The Medical Journal of Australia. This can have long-term life-threatening consequences. Infectious disease experts are urgently calling for this issue to be addressed before it gets worse.
AMR can result from high rates of antimicrobial prescription. The more an infection is treated with antibiotics, the higher the risk there is of the bacteria building up a tolerance against treatment. High prescription rates are due to the absence of senior clinical staff at hospitals who are knowledgeable of the proper course of treatment. Clinicians may prescribe unnecessary antibiotics to patients in remote areas just to be safe because hospitals are too far away in the event of an urgent complication from lack of treatment.
Socioeconomic factors such as overcrowding create an unending cycle of sickness with infections like strep throat. It is important that strep throat be treated with antibiotics to prevent fatal complications like rheumatic heart disease — but the more times someone is treated, the higher risk there is of AMR. Treatments for antibiotic-resistant infections are very expensive, which is unideal for remote communities with insufficient financial and medical resources. The more treatments that are eliminated due to AMR, the more expensive and difficult it will be to administer the right treatments to patients in remote areas.
AMR has already been observed in remote Indigenous communities: five remote areas reported 50–60% antibiotic resistance to Staphylococcus aureus (“golden staph”) bacteria, compared to 15% in the rest of Australia. Golden staph can cause skin infections, food poisoning, bloodstream poisoning, bone and joint infections, and more.
Skin diseases like scabies and impetigo are very common in ATSI communities, where skin plays a special role in forming kinship and identity in Aboriginal culture. Topical antimicrobials for impetigo prescribed in the Kimberley region during the 1990s led to a rapid rise in resistance in golden staph to these agents. Long-acting antimicrobials intended to reduce community disease burden have been shown to lead to pneumococcal resistance.
The Road to Stewardship
The key to slowing AMR is antimicrobial stewardship, “a set of coordinated strategies to improve antimicrobial use, enhance patient outcomes, reduce antimicrobial resistance, and decrease unnecessary costs.”
HOT North (Health Outcomes in the Tropical North) is an organization whose aim is to build the health research workforce across northern Australia. It has funded a pilot study looking at how to audit antimicrobial prescribing in the remote sector. Another one of its projects is SToP (See, Treat, Prevent) Skin Sores and Scabies, aimed at decreasing the burden of skin health in remote Indigenous communities in the Kimberley region. Eliminating skin disease in ATSI children could reduce antibiotic use by almost 20%.
Stewardship will require collecting better data about antimicrobial drug use and assisting doctors in which antimicrobials to prescribe and for how long. Addressing socioeconomic issues like overcrowding, poverty, and clean water access is essential for long-term progress. Better communication between doctors and patients is crucial and can be aided by providing educational material in patients’ native languages and more having more ATSI doctors in remote areas.
Read The Medical Journal of Australia’s paper here.