In November 2018, we were awarded a $2.5M Centre of Research Excellence in Minimising Antibiotic Resistance in the Community (CRE-MARC) to translate and extend this work in 5 Research Streams: (1&2) translation and uptake of our previous studies in Acute Respiratory Infections; 3) extend our scope to urinary tract infections, skin infections; 4) Aged Care Facilities.
Three major obstacles remain to reducing antibiotic use in Australian primary care:
- the poor adoption of several effective interventions for improving ARI prescribing, which emphasises that the next steps should be implementation research focussed on improving uptake of these interventions into practice;
- the need to broaden the focus beyond minimising antibiotic use in just acute respiratory infections (ARIs) and to include the two other major antibiotic indications in primary care – skin and soft-tissue infections (SSTIs) and urinary tract infections (UTIs); and
- the well-known, but little understood, problem of very high use of antibiotics in Residential Aged Care Facilities (RACFs).
Our previous NHMRC CRE in Minimising Antibiotic Resistance for Acute Respiratory Infections (ARI) - CREMARA (2012-2018), generated new knowledge about ARIs and antibiotic use in general practice.
Our research focussed on five main areas:
- Benefits and harms of antibiotics: updated reviews of benefits and new systematic reviews of harms will be done to correct the insufficient focus on harms which has distorted clinicians’ and patients’ benefits-harms judgement.
- Physical barriers: key elements of effective physical barrier interventions will be analysed in a meta-regression.
- Pharmaceutical packaging of antibiotics: we will research current packaging effects and community behaviours contributing to antibiotic resistance.
- Construction and validation of a causal model to determine relative contributions of each source of resistance and potential effect of each intervention. This will be informed by research in Areas 1-3 and epidemiological data.
- Development and evaluation of interventions to minimise antibiotic resistance: numerous innovative interventions, informed by research in Areas 1-4, and aimed at clinicians, patients, policy-makers and other key stakeholders, will be developed and evaluated.