Global project to drive lifesaving agreement on appropriate antimicrobial drug use
University of Melbourne researchers are leading a new push to address the growing harm of antimicrobial resistance (AMR) as more humans and animals become seriously ill or die from infections that medicine once treated easily.
Over-use and misuse of microbe-killing drugs – including antibiotics, antivirals and antifungals – is the main driver accelerating the evolution of resistance to these drugs in bacteria, viruses, fungi and parasites around the world.
The World Health Organisation calls AMR a top global public health threat that was directly responsible for 1.27 million deaths and contributed to 4.95 million deaths in 2019.
To help fight AMR, veterinary scientist Dr Laura Hardefeldt has secured almost $795,000 from the Medical Research Future Fund (MRFF) to develop a global standardised definition of ‘appropriate’ prescription to help doctors, vets, pharmacists and dentists use antimicrobial drugs correctly.
Currently, ‘appropriate’ drug use is conceived differently across healthcare sectors or geographical regions, so prescription policies and practices vary, increasing the risk of lethal consequences.
Image from Unsplash by Roberto Sorin
“AMR is a growing problem that threatens lives around the world,” Dr Hardefeldt said. “For example, in Australia, patients with drug-resistant urinary tract and blood stream infections are respectively 2.4 and 3.3 times more likely to die than patients with drug-sensitive infections.
“If we don’t find solutions to AMR, the annual cost to the Australian economy is estimated to reach more than $142 billion and up to $283 billion by 2050.”
Supported by an MRFF Early- to Mid-Career Researcher Grant, Dr Hardefeldt’s project aims to develop worldwide consensus among prescribing groups – including doctors in hospitals and general practice, pharmacists, dentists and vets – on the definition of ‘appropriate’ antimicrobial use.
“To combat AMR efficiently and effectively, we need international agreement on what’s appropriate so we can evaluate prescription practices against a standard metric and identify ways of improving them where necessary,” Dr Hardefeldt said.
“Reaching a consistent definition involves considering factors such as the patient’s characteristics, the basis for identifying the disease-causing microbe, the choice of drug or treatment, and the prescribed dose and duration of treatment.”
The project team is taking a One Health approach, acknowledging that human, animal and environmental wellbeing are connected.
“Resistant microbes or genetic material that confer AMR can move between species – for example, where animal manure contaminates human water supplies – so a One Health approach is essential,” Dr Hardefeldt said. “That’s why our research team includes medical researchers focused on infectious diseases in humans, experts in general medical practice and primary care, and dental and veterinary specialists.”
The team comprises nine chief investigators – all early- to mid-career researchers – as well as 15 associate investigators and 18 partner organisations. The collaboration involves the Melbourne Veterinary School, the University of Washington, Monash University, the University of NSW, and the Doherty Institute.
They will consult 30 to 50 diverse international experts, using a Delphi consensus method with rounds of surveys and feedback to help the experts reach agreement on a definition of appropriate antimicrobial use.
“We’ll then apply the consensus definition to existing data on prescriber practices to evaluate if it is feasible and usable. Finally, we’ll test how international prescribers, consumers, and policymakers interpret the definition, to assess its validity within these groups,” Dr Hardefeldt said.
“Developing a standard international measure for appropriateness of antimicrobial use is essential for further research to inform strategies that will maintain effective treatment options for current and future generations.”
Dr Laura Hardefeldt (with a miniature horse)