Abstract:
Antimicrobial stewardship is a set of coordinated strategies to improve antimicrobial use, enhance patient outcomes, reduce antimicrobial resistance (AMR) and decrease unnecessary costs. In Australian publicly funded health care, it is required for hospital accreditation under the National Standards, with highly developed strategies for hospitals (inpatient and outpatient) and nursing homes. Strategies in primary health care are much less developed, in settings where almost one in two Australians are prescribed an antibiotic every year.
The Coordinated Remote AntiMicrobial Stewardship (CRAMS) Group is funded by HOT North (Improving Health Outcomes in the Tropical North), a National Health and Medical Research Council Collaborative Research Program, which has AMR as one of its pillars. This network of doctors and pharmacists working in northern Australian primary health care (Kimberley Aboriginal Medical Services [Western Australia], Top End Health Service [Northern Territory] and Queensland Health) collaborate with researchers with experience in infectious diseases in remote Australia and antimicrobial stewardship.
We write this perspective to raise awareness of AMR as an issue in Indigenous primary health care and to foster ongoing consultation with Indigenous people and communities to identify potential solutions. We summarise what is known about infection burden, AMR and prescribing; review and identify critical gaps in current antimicrobial stewardship programs; and provide suggestions for improving and implementing stewardship programs in partnership with Indigenous communities and remote primary health care. Our proposed framework for antimicrobial stewardship leans heavily on urban tertiary hospital practices. This will need local adaptation (and perhaps complete rethinking) to be effective in remote primary health care.