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Speaker 1: Jack team and a disease physician is calling on healthcare

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Speaker 1: leaders to stop prescribing antibiotics to patients who don't need them.

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Speaker 1: Professor Mark Thomas has warned that New Zealand currently has

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Speaker 1: one of the highest antibiotic resistance rates in the world.

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Speaker 1: His briefing has encouraged if Utter Order and the Royal

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Speaker 1: College of GPS to set goals to reduce inappropriate antibiotic

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Speaker 1: prescribing and disease physician Professor Mark Thomas is with us

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Speaker 1: this evening high Mark, Hi Jack, So, why is New

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Speaker 1: Zealand ranking so poorly when it comes to antibartic prescriptions

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Speaker 1: and antibartic resistance.

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Speaker 2: It's just been a culture that has built up over

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Speaker 2: a long period of time, decades of gradually increasing, for

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Speaker 2: some decades rates of gradually increasing antibiotic prescribing for people

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Speaker 2: in the community. People in the community consume about ninety

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Speaker 2: five percent of all the antibiotics that are given to

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Speaker 2: people in New Zealand, so only five percent in hospitals.

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Speaker 2: Most of it's only and it's gradually gone up over

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Speaker 2: the years. It's actually peaked at about twenty and thirteen

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Speaker 2: twenty fourteen, and since then has been gradually coming down,

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Speaker 2: but it's but it had got up and it's still

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Speaker 2: is at high levels compared with most countries in the world.

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Speaker 1: And so for what things are people being inappropriately prescribed antibotics?

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Speaker 2: The things that most people are most commonly inappropriately prescribed

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Speaker 2: antibiotics are colds, the flu, cough, you know, an episode

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Speaker 2: of bronchitis, some children with mild episodes of titus media,

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Speaker 2: people who wouldn't get rheumatic fever but have a sore throat,

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Speaker 2: but have no risk of getting rheumatic fever from the

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Speaker 2: sore throat. So anybody who's not Mari or Pacific and

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Speaker 2: aged to thirty five, they shouldn't be getting antibotics for

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Speaker 2: a sore throat. So there's lots of what are called

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Speaker 2: upper respiratory tract infections. It's almost always caused by viruses.

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Speaker 1: I mean, I would have thought most doctors are pretty

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Speaker 1: old year of the concerns around antibartic resistance, So why

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Speaker 1: would they be prescribing antibotics for colds and viruses?

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Speaker 2: Well, you've got to think about it. It's a business interaction.

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Speaker 2: The patient is coming you, you don't have very much

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Speaker 2: time with them. As a general practitioner. You're under pressure

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Speaker 2: all the time. And some patients very strongly expect an

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Speaker 2: antibiotic for those sorts of infections. Others just don't know.

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Speaker 2: But it's sometimes difficult unless the GP asks, well, what

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Speaker 2: are you expecting? Do you want antibiotics or not? And

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Speaker 2: there's a time pressure, and for some patients there's the feeling, well,

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Speaker 2: I've come to see you, I've taken a lot of

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Speaker 2: time out of my day. My illness is dragged on.

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Speaker 2: I'm feeling terrible after five or six days, my snot's

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Speaker 2: gone green, I'm still coughing whatever else. Just give me

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Speaker 2: something neat or madam to fix it up. Yeah, and

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Speaker 2: quite a bit of pressure.

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Speaker 1: Yeah, you can understand that.

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Speaker 2: Yeah.

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Speaker 1: So what are the gold standard countries for antibartic prescriptions

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Speaker 1: and how might we do a better job of emulating

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Speaker 1: their processes?

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Speaker 2: The gold standard countries are the Netherlands, Sweden and some

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Speaker 2: of the other scan all much pretty much the other

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Speaker 2: Scandinavian countries, right, and what.

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Speaker 1: Do they do well that we don't?

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Speaker 2: Well, they don't. We have a big surge and antibiotic

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Speaker 2: prescribing through the autumn and winter and early spring months

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Speaker 2: when the viruses are spreading around a bit more because

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Speaker 2: we're more cramped up inside and they don't have a

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Speaker 2: big surge. Then they don't run a mark on giving

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Speaker 2: people antibiotics, you know during those months when people are

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Speaker 2: getting cops and colds, et cetera. Right, but they start

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Speaker 2: off with a lower baseline as well. Now we are

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Speaker 2: not the same as the Netherlands or Sweden. We have

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Speaker 2: a different population than them. We have more people, you know,

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Speaker 2: in relative poverty, and we have Marian passive people who

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Speaker 2: have a particular issue with getting rheumatic fever and some

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Speaker 2: other higher rate of all sorts of other infections as well.

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Speaker 2: So we will never get down to the same level

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Speaker 2: as them, but we could get closer to them without

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Speaker 2: having a deterioration in the health of the people of

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Speaker 2: New Zealand.

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Speaker 1: So talk to us about how you understand the goals

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Speaker 1: for reducing antibodic prescriptions are going to work. Do you

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Speaker 1: understand how that's going to function?

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Speaker 2: Yeah, I think if the Ministry of Health and or

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Speaker 2: the Royal College of General Practitioners said, we think that

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Speaker 2: a reduction each year of about five percent in the

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Speaker 2: rate of antibotic prescribing across the whole country would be

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Speaker 2: a good thing for a number of years. Then I

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Speaker 2: think GPS would respond to that encouragement, and I think

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Speaker 2: the general public would hear it and think, h yeah,

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Speaker 2: well we should be doing what they're saying. And I

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Speaker 2: won't put my GP under pressure. And maybe when I've

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Speaker 2: got a cold, I'll just stay at home because I

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Speaker 2: can look after myself perfectly well without getting given to

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Speaker 2: the doctor and expecting maybe some antibiotics.

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Speaker 1: As someone who's got a lot of expertise in the

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Speaker 1: space professor, what do you think about as being a

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Speaker 1: worst case pussibility in the near future. When it comes

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Speaker 1: to antibiotic resistance, it is.

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Speaker 2: A gradual thing. It's like, you know, pollution of rivers

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Speaker 2: and lakes with too much fertilizer. This is something the same.

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Speaker 2: It's pollution of the organisms or you know, a change

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Speaker 2: in the microbiome the families of bacteria that live in

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Speaker 2: us as a result of exposure to all the antibotics,

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Speaker 2: and it changes slowly, imperceptibly. That's why we tend to

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Speaker 2: forget about it. But it is changing. And what happens

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Speaker 2: is that eventually, and it's already happening to a very

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Speaker 2: small degree, but it's more overseas in some of the

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Speaker 2: countries that use even more antibotics than us. Is that

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Speaker 2: you see patients with bacterial infections and there's three or

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Speaker 2: four antibiotics that would have worked well against that bacterium

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Speaker 2: in the past, and there's none now that work against

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Speaker 2: that particular bacterium that that patient's got, and they end

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Speaker 2: up dying of the infection, or they end up having

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Speaker 2: to have the infected foot, for instance, cut off, because

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Speaker 2: you can't beat the infection with any antibiotics and so

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Speaker 2: you've just got to cut the foot off. So yeah,

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Speaker 2: those are those are the worst case scenarios that we

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Speaker 2: see increasing numbers of people with infections that can't be

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Speaker 2: treated and that cause catastrophe, and that will happen unfortunately

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Speaker 2: to the populations in New Zealand who have the highest

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Speaker 2: rates of infections and have the highest amount of anybodic treatment.

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Speaker 2: And that's going to be the relatively you know, underprivileged

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Speaker 2: people in our society and particularly Marian Pacific people. It

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Speaker 2: will be a terrible thing if we allow it to happen.

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Speaker 1: Thank you so much for your time, We really appreciate it.

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Speaker 1: That is Professor Mark Thomas For more from Hither duplessy

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