Australia’s infectious disease experts are urgently calling for high rates of antibiotic resistance in remote Indigenous communities to be addressed before communities come to a point where there are no treatment options available.

Research has shown these communities have the highest rates nationwide of antibiotic resistance to bacteria like golden staph, which can cause skin infections and in the most serious cases, sepsis.

“Aboriginal people living in remote communities [in northern Australia] would have a one in two chance of becoming very resistant to [golden staph],” said Associate Professor Asha Bowen, Head of Skin Health at the Wesfarmers Centre of Vaccines and Infectious Disease at the Telethon Kids Institute.

Approximately 50 percent of people are resistant compared to 15 percent in other places across Australia.

According to a recent article co-authored by Associate Professor Bowen, this is due to a substantial burden of infectious diseases in combination with high rates of antibiotic use.

The associate professor said although GPs have guidelines to follow to ensure they prescribe the right antibiotic, the limitation is that these guidelines are national and don’t take into account the resistance profiles in different parts of the country.

“It’s really important that local GPs know their information and that we have a coordinated approach to getting that information to GPs,” Associate Professor Bowen said.

“I think ultimately knowing as much about how antibiotics are being prescribed for different segments of the population, as well as knowing what the actual resistance profiles are for common bacteria in different parts of the population, will help us to be able to make sure that the right person gets the right antibiotic for the right treatment.”

Associate Professor Bowen said location specific guidelines would be very helpful in this instance, such as the CARPA (Central Australian Rural Practitioners Association) manual which has been in place since the early 1990s.

“We were trying to highlight [in our article] that there are wonderful guidelines but the data to inform those guidelines about how antibiotics are being prescribed as well as what the resistance profile is, is fairly poorly understood in the primary health care setting,” Associate Professor Bowen said.

“We really need to bring national attention to that problem in order to make sure that the skills and abilities and the conversation around antimicrobial resistance doesn’t leave out that really important priority population [remote Indigenous communities].”

The associate professor said if the spread of antibiotic resistance cannot be slowed, this will dangerously impact remote communities where life-threatening infections may have no treatment options available.

“We are aligned in a research project which has been funded the HOT NORTH (Health Outcomes in the Tropical North) which is a research collaboration out of the Menzies School of Health Research,” Associate Professor Bowen said.

“The HOT NORTH project has funded a pilot study looking at how to do an audit of prescribing in the remote sector.”

Associate Professor Bowen said she has been involved in this new study along with researchers from Kimberley Aboriginal Medical Service, Top End Health Service, Queensland health, and Victoria’s Doherty Institute.

While antibiotic resistance is an issue affecting remote Indigenous communities, it is only a symptom of larger problems such as clean water access and living conditions.

“The social determinants of health are something we all need to be aware of,” Associate Professor Bowen said.

“Overcrowded housing, poor health hardware and hygiene facilities that don’t always work – like taps that work to wash hands, showers, things like that – really do contribute to a high infection burden, which then contributes to the need for antibiotics and then antimicrobial resistance.”

Associate Professor Bowen said everyone needs to consider how to address social determinants of health and the benefits it will have across a range of other life outcomes for remote Indigenous communities.

By Hannah Cross