Future without antibiotics incomprehensible, but possible

The Choosing Wisely campaign is urging health professionals to be sure antibiotics are really needed before prescribing them.

Chair of the Choosing Wisely advisory group, Dr Derek Sherwood, says a future without antibiotics is almost incomprehensible – but it could become a reality.

“We are already seeing a growing number of infections, such as pneumonia, tuberculosis, and gonorrhoea becoming harder to treat as the antibiotics used to treat them become less effective. There simply aren’t enough new antibiotics being developed to battle increasingly drug resistant bacteria.

“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.”

Dr Sherwood says Choosing Wisely has worked with medical colleges and societies to develop specific recommendations about antibiotic use.

“These are available on our website and include recommendations related to infectious diseases, geriatric medicine, intensive care, internal medicine, surgery, paediatrics and dermatology.

“I encourage all health professionals to read the recommendations to ensure that when antibiotics are prescribed, they are absolutely needed.”

Choosing Wisely is run by the Council of Medical Colleges, with partners Consumer NZ and the Health Quality & Safety Commission. Its sponsors are Southern Cross Health Society, PHARMAC and Pacific Radiology. It has wide health sector support.

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

· Do not routinely prescribe oral antibiotics to children with fever without an identified bacterial infection.