Remote Indigenous children at risk as antibiotic resistance grows
Originally published on ABC News
Infectious diseases experts are urging immediate action to combat rising rates of antibiotic resistance in remote Indigenous communities.
A new paper published in the Medical Journal of Australia highlights the "urgent need" for antimicrobial stewardship — the process of trying to prevent the misuse of antibiotics.
Northeast Arnhem Land mother Fiona Djerrkura, a Yolngu woman, has seen the conversation around antibiotic use change over the years that she has been bringing her children to the doctor.
"My older children, who are now adults, there was definitely a pattern in regular prescription of antibiotics, particularly with those sorts of illnesses around ear infections, skin sores and things like that," Ms Djerrkura said.
Over the years, she has become more knowledgeable.
"I guess building up my confidence as well to have these conversations with my GP — I now have a better understanding of the potential risks involved in over-prescribing," she said.
An earlier study of the medical records of 400 children in five Arnhem Land communities found 95 per cent had received at least one antibiotic prescription by their first birthday, and almost half had received six prescriptions.
The World Health Organisation said antibiotic resistance is rising to "dangerously high" levels in all parts of the world, threatening the ability of health workers to treat common infections.
'Antimicrobial resistance high'
In remote Indigenous communities, skin sores, respiratory tract and ear infections and sore throats are common.
Dr Asha Bowen, head of skin health at Perth's Telethon Kids Institute, is one of the authors of the journal article.
"The problem of antimicrobial resistance is high in the remote Aboriginal sector," Dr Bowen said.
"And there's also a huge problem of infections that need to be treated.
"Clinicians do a great job of following guidelines and taking care of patients in remote and rural settings.
"The next level up is really having that level of oversight and understanding at a regional level what's going on with the use of antibiotics, and I think that's the level that's not there at the moment."
Research a 'call to arms'
Another author, Associate Professor Steven Tong from the Doherty Institute for Infectious Diseases, said the article was a call to arms.
"For a germ called staphylococcus aureus or golden staph, standard resistance rates in Australia are about 15 per cent," he said.
"But in many remote communities in northern and central Australia, it's up around 50 to 60 per cent, which makes treatment more difficult for these infections."
He said the issue had "been neglected".
"This is out in remote areas, it's not in major urban centres and therefore it's not entering into the public consciousness," he said.
Genuine need for antibiotic treatment
In remote communities where serious, preventable conditions like acute rheumatic fever and rheumatic heart disease can develop after repeated exposure to common infections, antibiotics can be an essential part of treatment.
Associate Professor Tong said that was why reducing infections should be a key focus.
"We know that in many communities, something like 40 to 50 per cent of kids will have skin infections at any one time," he said.
"These are infections that need treatment and therefore lots of antibiotics get used.
"If the antibiotics that we usually use to treat these infections no longer work, then we cannot effectively treat that infection.
"Not typically, but in some cases, it's almost like going back to pre-antibiotic era."
Dr Bowen agreed it was a "real struggle" and a key reason why antimicrobial stewardship was needed.
"We definitely don't want to say that we shouldn't be using antibiotics," she said.
"In fact, we do use them a lot more commonly in the remote sector because of the serious and dangerous infections that can occur."
Data needs to be informed from across nation
Ms Djerrkura said overcrowded housing was a major contributing factor to many issues in Yolngu communities — including when it came to taking medication.
"With so many other family members living under one roof, and all having their own illnesses, it's inevitable that you're constantly being sick and picking things up all the time," she said.
She also believed communication between healthcare workers and parents needed to be improved, and more resources in language should be created to help those conversations.
"I think it's definitely flying under the radar," she said of the rise of antibiotic-resistant illnesses.
"Yolngu people are very trusting of clinicians.
"I think there definitely needs to be more education and awareness around improving people's health literacy."
Menzies Research Fellow Dr Tereza Wozniack said she was developing a real-time surveillance system focused on key drug-resistant infections across northern Australia.
"We're really working with communities, with hospitals, clinicians, pharmacists, to make sure we can better understand what the burden of resistance is and the abuse and misuse of antibiotics," she said.
She said messaging around antibiotic use and misuse needed to be informed by data from different parts of Australia.