Campaigns pushing for Australians to stop taking antibiotics unnecessarily are beginning to cut through, as new data reveals the nation's antibiotic use has fallen for the first time in two decades.
Those declining rates, however, mask a growing problem.
The same research found antibiotics are still being overprescribed and misused, causing several dangerous bacteria to grow increasingly resistant to common medicines.
The third annual surveillance report from the Australian Commission on Safety and Quality in Healthcare, published on Thursday, warned that antibiotic resistance showed little sign of diminishing — and posed an ongoing and "substantial" risk to patient safety.
Common pathogens like E. coli, Salmonella and the bacteria that cause gonorrhoea were found to be among a group of organisms growing progressively resistant to major drug classes and — in some cases — to last-resort treatments.
More work is needed to reduce the inappropriate use of antibiotics, particularly in aged care homes and hospitals, according to John Turnidge, senior medical advisor at AURA, the Commission's antimicrobial surveillance system.
"Australians are still very high users of antibiotics … and we've got a long way to go to catch up to countries like the Netherlands, which we consider the benchmark," he said.
In 2017, more than 10 million Australians had at least one antibiotic dispensed, and more than 26 million prescriptions for antimicrobials were issued.
The report found a significant number of patients were prescribed antibiotics for conditions for which there is no evidence of benefit, including the flu.
"We've got to continue to get out there and educate the public and prescribers about inappropriate use," Professor Turnidge said.
Resistance rises in community
Of particular concern, Professor Turnidge said, is drug-resistant Staphylococcus aureus — better known as golden staph.
The common bacterium, which lives on people's skin and is mostly harmless, can cause a range of mild to severe infections, including meningitis and pneumonia.
"Everybody thinks of drug-resistant golden staph as a hospital problem. But now it's flipped on its head — it's actually a community problem," Professor Turnidge said.
The report found that although drug-resistant strains of golden staph had dropped in hospitals, they had increased elsewhere, particularly in aged care homes and remote regions.
"We've still got a number of antibiotics that we can use … But we know from experience that through the passage of time, resistant bugs pick up even more resistance," he said.
Professor Turnidge added that E. coli, the most common cause of urinary tract infections (UTIs), was also becoming "slowly resistant" to antibiotics, including to some reserve drugs.
"We don't want to end up in the situation where somebody with a common infection has to go to hospital to get intravenous antibiotics because there's nothing available in the community," he said.
But Trent Yarwood, an infectious diseases physician and director of the Queensland Antimicrobial Stewardship Program, said that was already happening.
"Everybody who works in infection has seen patients who have needed to be admitted to hospital or put on an intravenous antibiotic because there were no tablets available to treat those UTIs," Dr Yarwood said.
"It used to be that if you picked up one of those germs, it was likely from hospital.
"But we're seeing a lot more of these come in from the community now."
According to the report, multi-drug-resistant organisms were found in high numbers in aged care homes, where more than half of prescriptions were issued to residents with no signs or symptoms of infection.
Professor Turnidge said if the rise in antibiotic resistance continued to increase in the community, hospitals would come under further pressure to take care of people when pharmacy medications failed.
"It's not people dropping dead that's the big problem … it's people not being able to be treated in the community anymore."
Containing resistance is crucial
In addition to ensuring antibiotics are only given to people who absolutely need them, Professor Turnidge said good hygiene practices would continue to go a long way in containing the spread of antibiotic resistance.
"Hand washing is still very important to reduce risk of transmission of bugs, and therefore superbugs, from one person to another," he said.
According to the OECD, an average of 290 people die in Australia each year as a result of infections from eight drug-resistant bacteria.
Dr Yarwood stressed that efforts to contain the spread of antibiotic resistance were critical to modern medical care.
"People don't realise just how much of hospital care really revolves around antibiotics," he said.
"There's this perception that we can just use a new antibiotic or a different antibiotic — that the drug companies will just sort it out."
But Dr Yarwood said there wasn't as much antibiotic development happening as people thought, despite global need for new drugs.
"We don't have a lot of extra options up our sleeve, which is why it's really important that we preserve the antibiotics that we do have, and make sure they're effective as long possible."
