Antibiotic stewardship involves promoting the responsible and appropriate use of antibiotics to preserve their efficacy, ensuring that these life-saving medications remain effective for future generations.
A critical concept in the stewardship framework is minimising 'collateral damage', a term that, in the context of antibiotics, refers to the unintended harm caused by the misuse of antibiotics. This includes using antibiotics for viral infections, administering incorrect doses, or prescribing them for unnecessarily long durations.
Such practices create an environment where resistant bacteria can thrive, leading to infections caused by multidrug-resistant organisms and severe complications like superinfections or antibiotic-resistant Clostridioides difficile diarrhoea.
Prof Brink drew attention to the growing threat of AMR in South Africa and other regions, where pathogens like Klebsiella pneumoniae and Staphylococcus aureus exhibit alarmingly high resistance rates.
He advocated for a 'One Health' approach, integrating human, animal, and environmental health efforts to curb AMR. This approach includes reducing antibiotic use in agriculture, improving sanitation, and preventing environmental transmission of resistant bacteria.
The responsibility for tackling AMR largely falls on GPs, who prescribe the majority of antibiotics in primary care settings. One of the key drivers of resistance is the overprescription of antibiotics for viral infections, such as colds and respiratory tract infections, which are not treatable with antibiotics.
Studies show that a significant proportion of patients in South Africa mistakenly believe that antibiotics can cure viral infections, highlighting the urgent need for public education campaigns. However, limited funding has hindered large-scale awareness initiatives.
To address this, Prof Brink proposed several strategies for optimising antibiotic stewardship in primary care. One key approach is reducing diagnostic uncertainty, which can lead to unnecessary antibiotic prescriptions.
Tools like point-of-care CRP testing can help distinguish between bacterial and viral infections, allowing clinicians to make more informed decisions about whether antibiotics are necessary. Although implementing these tools in busy primary care settings can be challenging, advances in rapid diagnostic technology offer promising solutions.
Vaccination is another critical tool in the fight against AMR. Vaccines can prevent infections, thereby reducing the need for antibiotics. For example, South Africa’s rotavirus vaccine has significantly reduced antibiotic-treated diarrhoea in children, and maternal RSV vaccination has decreased antibiotic prescriptions for infants by 13%. Similarly, large-scale influenza vaccination campaigns have demonstrated a reduction in antibiotic use by up to 65%.
Education also plays a pivotal role in optimising stewardship. Prof Brink highlighted the importance of training healthcare providers, particularly GPs, in appropriate prescribing practices. Younger GPs tend to have better knowledge of antibiotic stewardship principles, underscoring the need for ongoing education and integration of stewardship training into medical curricula. Furthermore, collaboration with pharmacists, who play an underutilized but crucial role in stewardship, can enhance patient education and ensure proper antibiotic prescribing.
Finally, innovative approaches, such as bacteriophage therapy and an increased focus on the human microbiome, offer exciting potential for reducing AMR. Bacteriophages, which are viruses that target specific bacteria, present a promising alternative to traditional antibiotics in treating resistant infections. Understanding the microbiome’s role in resistance could lead to novel therapies that promote the growth of beneficial bacteria, further helping to combat resistance.
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