Yet in 2023, the global reality of antibiotic resistance (AMR) made it clear that we are losing this battle. One of every six laboratory-confirmed bacterial infections around the world were resistant to first-line antibiotic drugs. The downside trends in AMR are most alarming when it comes to E. coli. A mind-boggling 45% of those infections worldwide are resistant to important antibiotics called third-generation cephalosporins.
In Australia, the picture is slightly brighter but continues to represent a major danger. For a recent example, over one-fifth (21.5%) of pediatric E. coli infections showed resistance to these important antibiotics. Experts warn that while Australia’s AMR rates are lower than the global average, they still represent a considerable threat to pediatric healthcare.
Second, the rates of antibiotic resistance are, unfortunately, not even across states and regions. In Africa, almost one-fifth of infections showed AMR, showing a disturbing difference to the data we saw in Australia. Of course, the global health community should be alarmed by these numbers. They are especially worried about the impact of this on the treatment of frequent infections, such as gonorrhoea and Shigella.
Changes in gonorrhoea treatment have been made to address rising resistance to the antibiotics. Not now, with most cases needing injections or a combination of oral meds rather than just the usual oral prescriptions. Likewise, about 30% of gastrointestinal infections due to Shigella have recently become untreatable, signalling the start of endemic transmission of these infections.
Over the past five years, the rate of bloodstream infections from Salmonella has increased by 9% annually, signaling a growing public health challenge. In Australia, around half of all hospital inpatients are prescribed antimicrobials like broad-spectrum antibiotics for treatment of common infections.
That’s what the World Health Organization (WHO) found in a recent survey. It determined that many of the deadliest pathogens—those including our most lethal and resistant germs—are becoming more and more resistant, establishing a “vicious cycle” of resistance. As stated by Professor Karin Thursky, antimicrobial stewardship plays a key role in tackling the threats posed by AMR.
Anita Williams, M.D., FAAP, is a subspecialist in pediatric infectious diseases. She underscored that Australia has led the world on stewardship programs to curb the inappropriate use of antibiotics. She cautioned that resistance to first-line antibiotics like co-trimoxazole and Augmentin has seen a rise over the last decade.
“Since 2013, enterobacterials such as E. coli resistant to co-trimoxazole have increased from 16.9% to 24.8%, and resistance to Augmentin has increased from 4.2% to 12.8%,” – Anita Williams
Even with these obstacles, Williams stressed that Australian children face less resistance than the worldwide average.
“Globally, 45% of E. coli were resistant to third-generation cephalosporins. In Australian children, it was only 21.5%,” – Williams
The data paint a troubling portrait of the long-term harm expected for pediatric healthcare.
“These numbers represent a significant risk to paediatric healthcare in Australia,” – Williams
Medical professionals have long been raising the alarm about these high rates of antibiotic use in Australia, especially when compared to other countries with similar healthcare systems.
“The concern for us in Australia is that we do actually have quite high rates of antibiotic use compared to other similar countries. So it’s certainly something that we need to watch out for in the future,” – Dr. Andrew Yarwood
The mercurial financial climate taking shape around antibiotic development only muddies the waters more. For pharmaceutical companies, the return on new antibiotics is limited as these drugs will typically be prescribed for only short duration. Alternatively, drugs to treat chronic diseases create lucrative annuities.
“You might put someone on a week’s course of this new antibiotic and then that’s it. So the drug companies aren’t selling a lot of product,” – Thursky
Thursky recommended that federal measures be taken to address financial disincentives preventing innovation in antibiotic research.
“The government could create an incentive payment program to help drug companies actually overcome these financial barriers for doing new antibiotic research,” – Thursky
Thursky explained more about how the over-prescription of the strongest strengths of antibiotics is contributing to even greater resistance.
“At least one in three prescriptions is inappropriate, often because they’re not even needed to be used, particularly for upper respiratory tract or virus infections, or they’re not the right choice,” – Thursky
The multifaceted nature of AMR calls for the continued awareness and action of both healthcare providers and healthcare lawmakers.
“There often is a temptation for doctors to reach for a really strong antibiotic when a much narrower spectrum one is okay,” – Thursky
The complexities surrounding AMR necessitate vigilance and proactive measures from healthcare professionals and policymakers alike.
“You expose the germs to some antibiotics and just by random chance there’ll be one or two that are a bit resistant to that,” – Yarwood
