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a call for the judicious use of antibiotics

The development of a wide range of antibiotics has, perhaps not surprisingly, led to a level of complacency as far as infection control is concerned; there always appears to be another antibiotic to deal with resistant organisms.

This has led to a serious threat to patient safety in the form of antimicrobial resistance.

So what were the factors that led to this situation? Some factors include overprescribing, prolonged medication usage, widespread medication usage in animal husbandry, and medical tourism. The disturbing rise in anti-microbial resistance has required multiple responses from health professionals and researchers.

One response was to reduce the chance of infection by implementing hand hygiene practices. But although good hand hygiene is well proven to reduce cross-infection, it has been hard to implement and very few institutions have achieved 100% compliance even when staff were aware they were being observed.

The other response to reduce the likelihood of resistance was to avoid over-prescription and the inappropriate use of antibiotics. While it is well recognised that antibiotics are of no value in influenza or URTI, antimicrobials are still prescribed to more than fifty percent of patients presenting with these symptoms. This can be attributed to factors concerning both health professionals and patients.

For patients, health professionals face the challenge of shifting community expectations to persuade consumers that antibiotics are not required in certain circumstances.

For health professionals, there is still some work to do in decreasing total hospital prescribing, as one in four prescriptions are considered inappropriate (too broad or too narrow). These prescriptions often occur when guidelines are not followed, again indicating the need to constantly monitor performance and provide better education for all staff.

A new issue about the detrimental effects of antimicrobials has been theorised by Professor Martin Blaser, who states we live in a world of modern plague defined by the alarming rise of asthma, diabetes, obesity, food allergies and metabolic disorders. He argues that this is no accident; the common link is the destruction of vital gut bacteria through the overuse of broad-spectrum antibiotics.

Whether true or false, it again supports the need for the judicious use of antibiotics.

If you have implemented changes within your organisation to influence systems and processes, submit an abstract to present in the Clinical Governance section of our Patient Safety & Quality Care Symposium.

The Langford Oration, named in honour of the Royal Australasian College of Medical Adminstrators' (RACMA) Foundation President, the late Dr Sam Langford, is delivered by a distinguished person during the Conferment Ceremony. At the 2019 RACMA Conference, the speaker was Emeritus Professor Villis Marshall, who chose to discuss the topic of patient safety.