Aspects of medical care in Australia could regress to 1930s conditions if the rate of resistance to antibiotics isn't curbed soon, a report warns.
The study puts forward a range of remedies and calls for a multi-pronged national strategy to avert dire consequences, including some operations becoming too dangerous to perform.
The report's authors, led by Professor Chris Del Mar from Bond University's Centre for Research in Evidence-Based Practice, said that already about 1600 people in Australia die annually from antibiotic resistance .
"It will get steadily worse until 2050, when deaths from currently treated infections will overtake total cancer deaths," says the report, published on Monday in the Medical Journal of Australia.
Without reliable antibiotic effectiveness, procedures such as chemotherapy and bone marrow transplants, major surgery such as joint replacement, and invasive diagnostic procedures such as cardiac catheterisation "will become too dangerous to perform".
"Many aspects of medical care will retreat into the pre-antibiotic era of the 1930s, the economic consequences of which are catastrophic and have prompted the Chief Medical Officer of the United Kingdom to declare this threat every bit as serious as terrorism," the report says.
Called Reducing antibiotic prescribing in Australian general practice, it recommends national monitoring of antibiotic prescribing and resistance levels, but also calls for, in GP clinics:
- Regulatory interventions such as GP clinical software adopting "no repeats" prescriptions as a default, restricting access to some antibiotics such as quinolones, and the elimination of surplus doses on prescriptions.
- Externally administered interventions such as giving feedback to clinicians about their prescribing habits compared with their peers.
- GP implementation techniques such as delayed prescribing - advising patients to only fill prescriptions if symptoms get worse or don't clear up in a specified time, and shared decision-making - GPs going over pros and cons with patients to come to the best management option.
Dr Lorraine Baker, Victorian president of the Australian Medical Association, said the issue of increasing antibiotic resistance "does have be taken seriously, and everyone in the medical profession has a part to play, as does government, in managing this".
She said one option would be for the Pharmaceutical Benefits Scheme to not allow repeat prescriptions without its authority.
The practice of GPs receiving feedback on prescription levels had been in place for "many years".
Delayed prescribing was "potentially flawed" because a patient might fill the script at a later date, for another illness, without medical assessment.
Dr Baker supported shared decision-making with patients, but there were time, and patient health literacy, barriers.
Dr Baker said that if a patient requested antibiotics and wasn't critically ill, sometimes it helped to educate them, for example, on the difference between viral and bacterial infections; on their capacity to overcome bacterial infection; and if necessary ordering blood tests or respiratory swabs.
It could help to advise "that not everything they present with is treatable with antibiotics".
