Antibiotic misuse and resistance
When Kate’s nine-year-old daughter, Josie*, started showing signs of a urinary tract infection, the Sydney mother’s first thought was antibiotics.
“Josie has had UTIs before so, as soon as she started to complain of ‘a sting’, I knew what was happening,” says Kate, who is also prone to the bacterial infection.
In fact, she was so confident her daughter needed antibiotics that, without consulting a GP, Kate ransacked her medicine cabinet looking for old amoxicillin or an unused script.
Her search came up empty, so she drove Josie to the nearest hospital emergency room. “I was adamant that she needed to start antibiotics straight away, so I didn’t want to wait till the next day. UTIs can spread to the kidneys. I was worried,” says Kate.
The ER was quiet that evening and Josie was seen within an hour. After testing her urine the doctor on duty revealed Kate was right – Josie did have a UTI. But the test also showed Josie’s body was already fighting the infection.
“The doctor said that she didn’t think antibiotics were necessary. She gave us a script in case things got worse but she seemed confident we wouldn’t need it. I felt quite foolish – I’d been so sure Josie needed antibiotics,” says Kate.
Kate’s scramble to find antibiotics for her daughter is far from uncommon. New research conducted by the Royal Children’s Hospital (RCH) in Melbourne found almost one in five Australian parents has given their child antibiotics during the past 12 months either before seeing a doctor or without seeing one at all.
Dr Anthea Rhodes, a paediatrician and director of the RCH National Child Health Poll, says she was surprised and concerned by the finding. “It means that there are children who are unwell, who are perhaps not getting the medical review they might need,” she says. “It shows us that a large proportion of children may in fact be getting antibiotics when they don’t need that treatment.”
It’s this point that has researchers worried. Antibiotic resistance, the process where bacteria evolve in such a way that treatment with an antibiotic is no longer effective, is a growing problem worldwide. In fact, the World Health Organization says antibiotic resistance is one of the biggest threats to human health. Taking antibiotics when they are not needed is one of the factors that is causing this global problem.
Antibiotic resistance has a number of serious health consequences, says Rhodes. “It basically means those antibiotics stop working for some people, for some conditions, where they would have worked before.”
Without effective antibiotics, she says, we’ll see a rise of “super bugs”.
“We’ll see more and more situations where an infection caused by a bacteria that would have been very treatable by an antibiotic no longer responds to that antibiotic,” she says. “Antibiotic resistance is not some far-off, distant issue that affects other people outside of our country. It’s going to be a problem.”
Dr Mark Morgan, a spokesperson for the Royal Australian College of General Practitioners and a member of the Australian Strategic and Technical Advisory Group on Antimicrobial Resistance, says the issue of antibiotic resistance is very scary.
“[It’s] akin to global warming actually. Antibiotic resistance is the disaster that’s just around the corner for us all,” he says. “We could no longer have elective surgery [such as joint replacements] or give chemotherapy safely. All of those things will become very difficult if antibiotics are no longer relied on to work.”
While researchers understand the consequences of antibiotic resistance, the new data shows that parents are ambivalent. Seventy-one per cent of parents surveyed for the RCH study said they’d heard of antibiotic resistance, and yet, as the data shows, that awareness didn’t affect their decision-making.
So why isn’t there a greater fear of antibiotic resistance? Morgan notes that we’re living in times where there are a lot of things to be scared about. “I think it’s really like all future problems – it’s nicer to bury your head in the sand and hope that technology or new antibiotics will come along and solve the problem,” he says.
Anthea Rhodes says to combat antibiotic resistance, more education is needed about the dangers. “We need to motivate everyone to actually realise this is a problem for all of us to be aware of when we’re thinking about how to use antibiotics,” she says.
The RCH study, which was published in the Journal of Antimicrobial Chemotherapy, surveyed 2157 parents caring for 3971 children. As well as finding alarming numbers of parents giving their children antibiotics without medical advice, researchers also discovered that 38 per cent of parents incorrectly believed antibiotics are needed for viral infections such as the common cold and influenza.
“The research shows us that Australian parents are confused about antibiotics,” says Rhodes.
She says GPs sometimes feel pressured into giving patients antibiotics. “Other research has shown that there is an expectation sometimes from patients for antibiotics [including from parents, for antibiotics for their child]. And that can be very difficult for a doctor to navigate.”
Mark Morgan, who is also a professor of general practice at Bond University, says he has observed an exaggerated understanding of the difference antibiotics can make to the course of illnesses. “The belief in the power of antibiotics to speed recovery is far in excess of the real truth of how much antibiotics can help,” he says. “There’s been a lifetime of watching people get better from these illnesses in the context of being prescribed antibiotics.”
Perhaps this belief in antibiotics is why Australia has one of the highest rates of antibiotic use in the world. One study, published in The Medical Journal of Australia, found that Australian GPs are prescribing antibiotics at up to nine times the recommended rate.
In addition to putting pressure on doctors, the RCH research found that some parents will visit multiple GPs until they get the prescription they’re looking for.
“We have to remember that parents are doing this because they’re worried about their child,” says Rhodes. “They’re doing this because they believe that this is something that is going to make a real difference; that they need to get hold of a treatment that is going to be effective.”
Rhodes says the best education campaigns are ones that reach people in a variety of ways, including social media. But GPs and other health workers have a big part to play. “At the point of care when [a patient] sees a healthcare provider, they get that education alongside the decision about whether or not to prescribe antibiotics,” she says.
“If they continue to hear that same message again and again, it will be easier for people to start to understand and believe it.”
This article was first published in the print edition of The Saturday Paper on Apr 11, 2020 as "Dose of reality".
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