THURSDAY 17 NOVEMBER 2016
ANTIBIOTICS AND GUT HEALTH: FINDING THE RIGHT BALANCE

This Antibiotic Awareness Week (14-20 November), Australians are being urged to handle antibiotics with care—not just because of the threat of antibiotic resistance, but because their use can also result in significant side effects.

NPS MedicineWise medical adviser Dr Jeannie Yoo says that as well as adding to the threat of antibiotic resistance, antibiotics have other risks, and people need to weigh up the benefits of taking these medicines against possible harm. 

“Antibiotics play an important role in the treatment of serious bacterial infections, but like all medicines, antibiotics have the potential to cause side effects,” says Dr Yoo.

“At a community level, the evolution of resistant bacteria to an increasing number of commonly prescribed antibiotic medicines has become a global threat. To the individual, antibiotic therapy can have side effects that impact on their health.”

Antibiotics and the gut

“Although many people may be aware of the potential side effects of antibiotics, they may be surprised about how common they are,” says Dr Yoo.

Some of these side effects are short-term, for example between 1 and 10 in every 100 people taking antibiotics will experience common side effects such as stomach problems like diarrhoea, nausea and vomiting.

These side effects occur because, in addition to targeting the pathogenic (“bad”) bacteria causing the infection, the antibiotic can also disturb the balance of helpful bacteria living in the gut. Because of this disturbance the intestines may be less able to absorb water and nutrients from food, resulting in diarrhoea. 

In most cases these side effects are temporary.  However, studies have also reported that in situations where the makeup of the gut bacteria is altered following antibiotic therapy, there is an increased risk of disease from pathogenic (“bad”) bacteria such as Clostridium difficile. Infection with this bacteria can lead to serious, life-threatening diarrhoea.

Longer-term impact

Increasingly, research is showing there are also long-term consequences from antibiotic therapy that can impact on future health of the individual, as well as the community.

“Until recently, the impact of antibiotics on the normal gut bacteria was thought to be temporary, or short-term, with any disturbances being restored several weeks after treatment. However, emerging research now suggests the effect may be more long-term in some people, with imbalances still present months and even years after a course of antibiotics,” says Dr Yoo.

“Different antibiotics can have different effects on the gut bacteria, and how significant the effect might be to a person’s health will also depend on the strength (dose) of the medicine, how long it is taken for, if it is narrow- or broad-spectrum and how it is taken (e.g. oral, topical or injection).”

Handle antibiotics with care

“The fact is that antibiotics do cause side effects,” says Dr Yoo.

“In certain clinical situations, the benefits of antibiotics far outweigh the risks and that’s when they should be taken. However, by taking antibiotics when they are not needed, such as for self-limiting infections (infections that will get better on their own), you are unnecessarily risking both short-term side effects and longer-term effects on your gut health. We also need to appreciate that the health of the gut impacts on overall health, making the effects of antibiotics potentially far reaching. 

“This Antibiotic Awareness Week we’re urging consumers and health professionals alike to use these precious medicines carefully and appropriately, to ensure that we can continue to enjoy their benefits without unnecessarily experiencing their potential harms.”

About the global Antibiotic Awareness Week

NPS MedicineWise is working with organisations around the world to encourage the responsible use of antibiotics across the health sector, agriculture, industry, and communities to reduce the threat of antibiotic resistance.

To find out more, and to access resources so you can get involved in this year’s Antibiotic Awareness Week, go tonps.org.au/aaw2016

MONDAY 14 NOVEMBER 2016
ANTIBIOTIC RESISTANCE: HERE AND NOW

This global Antibiotic Awareness Week (14-20 November 2016), Australians are being urged to understand that antibiotic resistance is happening here and now, with increased rates of resistance being reported to many commonly-used antibiotics.

A new article from NPS MedicineWise (to be published Monday 14 November) describes how penicillins continue to be the most commonly-prescribed group of antibiotics in Australia, however, recent Australian data has suggested their ability to work against certain bacteria may be at risk.

NPS MedicineWise medical adviser Dr Andrew Boyden says that antibiotic resistance happens when bacteria change to protect themselves from an antibiotic. When this happens, antibiotics that previously would have killed the bacteria, or stopped them from multiplying, no longer work.

Antibiotics still prolific in Australia

Australia has high antibiotic prescribing rates, with more than 30 million prescriptions for antibiotics provided to Australians in 2014. Nearly half of the Australian population were prescribed at least one course of antibiotics.

“The more antibiotics are used, the more chances bacteria have to become resistant to them,” says Dr Boyden.

“Antibiotic-resistant bacteria can develop after antibiotic use. People can pass resistant bacteria on to others in a number of ways including through coughing or contact with contaminated hands, which is why hand hygiene is so important.”

Infections increasingly harder to treat

Spokesperson for the Australasian Society for Infectious Diseases, Associate Professor Katie Flanagan says that she and her colleagues are seeing an alarming increase in antibiotic resistant organisms in our hospitals, even among patients that have never been admitted to hospital previously.

“Many patients carrying these organisms have to be managed in individual rooms with private bathrooms, and the medical staff have to wear gloves and gowns for each patient encounter,” she says.

“In some cases the patients are simply colonised but not unwell with the organism (e.g. carrying the organisms on their skin or mucosal surfaces), but if they develop an invasive infection they can be difficult to treat because they don’t respond to first line antibiotic therapy.

“More worryingly, we are now starting to see cases of resistance to our last resort antibiotics such as meropenem, and are therefore facing a future where some infections may be impossible to treat.”

Pledge to handle antibiotics with care

Dr Boyden says the reality is that antibiotics are losing their power, but this Antibiotic Awareness Week—which has the theme ‘handle with care’—everyone can be part of the solution with their everyday behaviour.

“You can make antibiotic resistance worse if you use antibiotics when you don’t need them, use old packs of antibiotics for a new infection, share antibiotics among friends or family, or fail to take antibiotics as your doctor prescribes, including the right amount and at the right time,” he says. 

This Antibiotic Awareness Week, individuals can pledge to do five things to reduce antibiotic resistance:

• I will not ask for antibiotics for colds and the flu as they have no effect on viruses
• I understand that antibiotics will not help me recover faster from a viral infection
• I will only take antibiotics in the way they have been prescribed
• I understand that it is possible to pass on antibiotic resistant bacteria to others
• I will make a greater effort to prevent the spread of germs by practising good hygiene

Prescribing is on the improve

Evidence suggests that inappropriate antibiotic prescribing by health professionals may be decreasing. For example, according to BEACH data, systemic antibiotics prescribed for acute upper respiratory tract infections have dropped from 32.8% of presentations in 2011-2012 to 29.0% in 2013-2014.

This evidence is examined in a new article for health professionals (to be published on Monday 14 November) by NPSMedicineWise.

However, prescribing data indicate that antibiotics are still being frequently prescribed in situations that are not consistent with evidence-based guidelines, and that antibiotic type is sometimes not optimal.

Ongoing campaign for change

NPS MedicineWise has an ongoing campaign to raise awareness about the serious public health issue of antibiotic resistance, and create behaviour changes that drive down inappropriate prescribing in Australia by health professionals and the misuse of antibiotics by consumers.

For Antibiotic Awareness Week 2016, NPS MedicineWise is again working with key national and international organisations in response to the growing problem of antibiotic resistance.

To find out more, and to get involved in this year’s global Antibiotic Awareness Week, go to nps.org.au/aaw2016

 

10 NOVEMBER 2016
HELP HALT THE BUGS THIS ANTIBIOTIC AWARENESS WEEK

Hand hygiene is in the spotlight as a way of preventing the spread of infection, with Antibiotic Awareness Week kicking off next week (14-20 November 2016).

During the global Antibiotic Awareness Week, NPS MedicineWise will be reminding Australians that regular hand washing is an important part of preventing illness and stopping the spread of infection-causing bacteria—and that less bacterial infection can reduce the need for antibiotics 

Simple soap and water is best

NPS MedicineWise medical adviser Dr Jeannie Yoo says that regular hand washing using soap and water is a simple action to help stop the spread of bacterial infections.

“For adults and children moving about in the community, washing with simple soap and water is the best way to reduce the number of germs on hands, in most situations,” says Dr Yoo.

“Although the soap and water doesn’t kill them, washing your hands using the correct technique for at least 30 seconds physically removes the majority of bacteria and other germs from your skin.”

If soap and water are not available, the next best option is an alcohol-based sanitiser that contains at least 60% alcohol.

Hand washing can reduce illness 

President of the Australasian College for Infection Prevention and Control, Professor Ramon Shaban says that hand washing is a highly effective way to prevent the spread of communicable diseases that are spread by contact, such as diarrhoeal and respiratory infections.

“There is strong evidence that hand washing and hand hygiene is effective in reducing the spread of organisms that cause infection and disease. Removing the organisms using soap and water, and in some instances destroying them with alcohol-based hand rub solutions, is fundamental to breaking the chain of infection and to ensuring good health for individuals and communities,” he says. 

Antibacterial soap has disadvantages as well as being ineffective

Antibacterial hand soaps have become commonly available in recent years but emerging evidence now shows that antibacterial chemicals can affect the balance of bacteria in your gut, and also may make bacteria more resistant to some antibiotics.

Resistance to common antibacterial ingredients such as triclosan and triclocarban—and cross-resistance to antimicrobials have been consistently demonstrated in laboratory settings.

The benefits of antibacterial hand soaps have also been called into question following the ban by the U.S. Food and Drug Administration on antibacterial agents triclosan and triclocarban from over-the-counter antibacterial hand and body washes in September 2016 .

“There is little evidence that the addition of antibacterials to over-the-counter soaps and other types of cleaners wards off infection better than regular neutral soap,” says Dr Yoo.

“Although antibacterial hand soaps contain low concentrations of ingredients that can kill bacteria, they are only effective when used during long washes of over 30 seconds, multiple times a day, and for days at a time. But we know that most people only wash their hands for a few seconds.

“By going overboard and trying to establish a sterile environment we may actually be increasing the population of bacteria that are highly resistant to antibacterials and, possibly, to antibiotics.

“This Antibiotic Awareness Week, we want people to think of antibiotics as a precious resource, and to do everything they can—such as good old-fashioned hand washing with plain soap and water—to prevent infections in the first place.” 

To find out more, and to access resources so you can get involved in this year’s Antibiotic Awareness Week, go tonps.org.au/aaw2016

NPS MedicineWise has also published a one-minute video, ‘Six steps to clean hands’, available on our YouTube channel.

 

9 NOVEMBER 2016
Antibiotic Awareness Week 2016: tackling a global health problem