With some infections already becoming harder to treat Antibiotic Awareness Week this year focuses on reducing unnecessary antibiotic use – with WHO statistics showing Kiwis are prescribed more antibiotics a year than the average European.

The World Health Organisation (WHO) released antibiotic use statistics this week from 65 countries which showed New Zealand community health professionals prescribed 36 tonnes of antibiotics in 2015. This was the equivalent to 22.6 defined daily doses (DDD) per 1000 people compared to an average of 17.9 in Europe, 20 in the UK, 17 in Canada and 14 in Japan. Two of the lowest rates in wealthy countries were Germany with 11.5 and the Netherlands with 9.78.

The Ministry of Health, PHARMAC, ACC, the Health Quality & Safety Commission and the Council of Medical College’s Choosing Wisely campaign have banded together to support this year’s World Antibiotic Awareness Week.

Dr Sally Roberts, clinical lead for the Commission’s infection prevention and control programme, said the time taken to develop new antibiotics, combined with a lack of incentive for pharmaceutical companies to produce them, means antibiotic resistance – when bacteria are exposed to an antibiotic and change to resist its effects – is an increasing threat.

“With antibiotic resistance on the rise globally, it’s vital that we preserve the remaining antibiotics we do have. They need to be treated as precious commodities and not used indiscriminately when they aren’t necessary.

“Avoiding infections in the first place reduces the amount of antibiotics that have to be used, therefore reducing the opportunity for germs to develop resistance to them. The best way to avoid infections is to clean your hands regularly and thoroughly.”

WHO spokesperson Dr Suzanne Hill said overuse and misuse of antibiotics are the leading causes of antimicrobial resistance which could see the world lose its ability to treat common infections.  She said the findings of the WHO report confirmed the need to take urgent action with some countries consumption as high as 64 DDD – a risk heightened by some countries not enforcing prescription-only policies for antibiotics.

Chair of the Choosing Wisely advisory group, Dr Derek Sherwood, said a future without antibiotics was almost incomprehensible – but it could become a reality and urged New Zealand health professionals to be sure antibiotics were really needed before prescribing them.

“Without antibiotics, diseases like pneumonia would again become regularly fatal. Other common diseases treated by antibiotics include meningitis, tuberculosis, Strep throat, staph infections, and ear infections. It is frightening to think we may be heading for a world without effective treatment for these illnesses.” (See Choosing Wisely recommendations below).

The WHO report found that  amoxicillin and amoxicillin/clavulanic acid were the most frequently used antibiotics worldwide and were also the medicines WHO recommended as first or second-line treatments for common infections and were categorized in the ‘access’ list of the WHO Model List of Essential Medicines.

Broad-spectrum antibiotics, such as third-generation cephalosporins, quinolones and carbapenems, are categorised by WHO as “Watch” antibiotics that should be used with caution because of their high potential to cause antimicrobial resistance and/or their side-effects. The WHO report shows a wide range in consumption of ‘Watch’ antibiotics from less than 20% of total antibiotic consumption in some countries to more than 50% in others.

New Zealand (which only provided statistics on primary health prescribing and not public hospitals)  had around 80% of its antibiotic consumption from the ‘access’ group of antibiotics, about 14.5 per cent from the ‘watch’ group and 4.3% from the ‘other’ group. This compared to Japan where only 11% were from the ‘Access’ group’, more than 76.2% from ‘Watch’, about 12 per cent from ‘other’ and 1% from ‘reserve’ (the last-resort antibiotics used for multidrug resistant bacteria).  Overall WHO found that ‘reserve’ antibiotics accounted for less than 2 per cent of total antibiotic consumption in the 65 countries in the study.

New Zealand’s antibiotic consumption was dominated by penicillins (like amoxicillin and amoxicillin/clavulanic acid) which made up 44% of total consumption followed by tetracyclines and macrolides/lincosamides/streptogramins which were 29% and 13% of total consumption respectively.

Choosing Wisely recommendations relating to antibiotics

Australasian Society for Infectious Diseases

  • Do not use antibiotics in asymptomatic bacteriuria.
  • Do not take a swab or use antibiotics for the management of a leg ulcer without clinical infection.
  • Avoid prescribing antibiotics for upper respiratory tract infection.

Australian and New Zealand Society for Geriatric Medicine

  • Do not use antimicrobials to treat bacteriuria in older adults where specific urinary tract symptoms are not present.

College of Intensive Care Medicine of Australia And New Zealand

  • Consider antibiotic de-escalation daily.

Internal Medicine Society of Australia And New Zealand

  • Once patients have become afebrile (non-feverish) and are clinically improving, don’t continue prescribing intravenous antibiotics to those with uncomplicated infections and no high-risk features if they are tolerant of oral antibiotics.

New Zealand and Australian Societies of Otolaryngology Head and Neck Surgery

  • Don’t prescribe oral antibiotics for uncomplicated acute discharge from grommets.
  • Don’t prescribe oral antibiotics for uncomplicated acute otitis externa.

New Zealand Dermatological Society

  • Don’t use oral antibiotics for the treatment of atopic dermatitis unless there is clinical evidence of infection.
  • Don’t routinely use topical antibiotics on a surgical wound.

Paediatrics & Child Health

  • Donot routinely prescribe oral antibiotics to children with fever without an identified bacterial infection.

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