Shortage of antibiotics puts Aboriginal children at risk

At any given time, nearly one in two Aboriginal children living in remote areas will have a school injury. This means that currently about 15,000 children need treatment.

School lesions can be painful and itchy. But if they are not treated, they can lead to rheumatic fever, bone infections or sepsis.

The most effective and tolerable antibiotic for treating school wounds is lacking, putting Aboriginal children at risk for life-threatening infections.

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What are the school wounds?

School wounds (or impetigo) are common among Aboriginal children living in remote areas because of their badociation with scabies, ringworm and lice, which are also very common.

When the skin or scalp becomes itchy, children can scratch and break their skin, leaving the bacteria responsible for the wounds. Insect bites and minor trauma can also become a site for the development of a school wound.

School wounds are caused by the bacteria Staphylococcus aureus and group A streptococci. These bacteria are highly contagious and are easily transmitted from one child to another.

What are the treatment options?

School wounds are usually treated with antibiotic cream when only a few children have them. But as these wounds are so common in isolated communities, it is recommended to use an oral antibiotic or injection to prevent the development of antibiotic resistance.

The oral antibiotic and injection work well for treating school wounds, but we know that many children will not want the needle.

Current recommendations recommend treating school lesions with the antibiotic trimethoprim-sulfamethoxazole (known as Bactrim and Septrin).

Most children under the age of eight must take a liquid antibiotic. Bactrim Brand Antibiotic Syrup is tasty and easy to swallow. Naturally, children prefer a painful injection.

In September 2018, Bactrim syrup was withdrawn from the market, probably due to a merger of the company, leaving the Septrin brand at the rank of the only remaining brand of this antibiotic in syrup form.

This put a lot of pressure on the company that makes Septrin to increase the supply needed for children everywhere in Australia. But they could not keep up with the request. Septrin syrup has been out of stock for eight months, which has affected the treatment of a large number of Aboriginal children with school wounds.

The alternative for younger children is to crush the trimethoprim / sulfamethoxazole tablets, whose taste is deplorable and which are not recommended by antibiotic regulators. It is not very accurate to get the right dose, especially for the little ones.

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For example, a two-year-old child will weigh about 12 kg. The recommended dose of trimethoprim / sulfamethoxazole in a child of this weight is 48 mg trimethoprim. The tablets come only in trimethoprim 40 mg or trimethoprim 80 mg, which makes it difficult to obtain the required dose for this child. And since the guidelines did not anticipate this situation, there is not much to inform dosing decisions.

In recent months, we have heard that reducible tablets from another brand of the same drug, known as Resprim, were also out of stock.

How can antibiotics needed by children disappear?

Drug shortages are a huge problem in health care.

Information about these stock-out filters for physicians and pharmacists is taken at random. There is no coordinated process for this in Australia, and it can take weeks, if not months, for the information to reach health workers. Often, they only realize the lack when a patient needs antibiotics.

The mandatory reporting of drug shortages to the Therapeutics Good Administration (TGA) by manufacturers began in 2018 to address this problem. Time will tell if this facilitates the flow of information.

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These problems are never simple. Old, cheap antibiotics are no longer patented and are generally not cost-effective for manufacturers. These antibiotics are usually prescribed for short cycles of three to five days and are therefore rarely prioritized over long-term medications required by the older population (such as diabetes or heart medications).

In a developed country with world-clbad health care, it is unacceptable that an antibiotic needed to treat an infection is not available because we do not have a national system for coordinating and maintaining the supply of antibiotics .

Why this shortage of medicines is particularly worrying

Skin wounds are more than a harmful condition. They make children feel sick, take weeks to heal and can lead to school absences.

The long-term problems of rheumatic fever, sepsis and kidney disease result in a chronic chronic disease and cost the health care system much more than a cheap oral antibiotic therapy to treat the lesions. before they become a more serious problem.

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With 15,000 Aboriginal children needing this antibiotic at a time to treat wounds in school, the demand is real.

Zoy Goff, pharmacist in charge of antimicrobial management at Perth Children's Hospital, and Hannah Mann, a Kimberley-based regional pharmacist and research partner for Kimberley-based skin health trials, contributed to this article.