Table 4

Key barriers and proposed solutions relating to AMR and antimicrobial use

Key barriersProposed solutions
Potentially divisive arguments of human versus animal use
  • Develop joint National AMR Strategy with input from all sectors.

  • Restrict use of antimicrobials in agriculture to those with limited cross-over resistance.

  • Companion animals to have the same access as humans.

Companion animals are excluded from agriculture and health portfolios
  • Provide a ‘home’ for companion animal health within the Commonwealth government structures.

  • Provide AMR prescribing guidelines for companion animals, including antimicrobial stewardship programmes and improved infection control.

Problem of attribution
  • Elucidate sources of AMR organisms including in humans (hospital vs community), animals (companion vs livestock vs wildlife) and environment (eg, water or soil).

  • Provide research funding for negative impacts on ecosystems and animal health, irrespective of human health.

Limited funding for multidisciplinary research
  • Provide funding avenues for multidisciplinary research, especially those combining human, animal and environmental health.

  • Consider dedicated funding provision from the new MRFF.

Global/regional rather than a national problem
  • Focus on AMR (including growing drug resistance in tuberculosis and malaria) as part of the DFAT regional Health Security agenda.

  • Strengthened international/regional AMR legislation, improved governance and stewardship should be key international development outcomes.

  • WHO to develop better global AMR accountability measures.

Spread of mobile resistance elements
  • Understand and monitor the mobile genetic pool, including spread by wild animals and bird populations.

  • Support regional/global strategies.

Antimicrobials are cheap and easily available
  • Restrict prescribing of certain antimicrobials.

  • Consider deferred prescribing if uncertain diagnosis and not acutely ill.

  • Consider ways to make antimicrobials more expensive,* without restricting access for people who need them.

Unnecessary supply and perceived public demand
  • Educate children and the public about responsible antimicrobial use.

  • Institute effective antimicrobial stewardship programmes.

  • Make institutional antimicrobial use and drug resistance profiles public.

Inadequate infection control leading to transmission of AMR organisms
  • Improved sanitation and environmental hygiene.

  • Better infection control practice in hospitals and other healthcare settings.

  • Better infection control awareness in the general community and targeted measures in congregate settings.

Poor communication and collaboration between states
  • Standard approach taken across states and territories.

  • Standardise susceptibility testing, surveillance, governance and antimicrobial stewardship procedures.

  • Consider routine reporting of drug-resistant infections as good clinical practice (laboratory accreditation requirement).

Antimicrobial development deliver poor return on investment
  • Recognise the failure of standard market mechanisms

  • Advocate for the development of alternative funding models, including consideration of public–private partnerships or a health insurance model.

  • Develop less expensive adaptive trial strategies.

  • *There was concern that an imposed AMR tax may limit or distort appropriate use in people who really need antibiotics.

  • AMR, antimicrobial resistance; DFAT, Australian Department of Foreign Affairs and Trade; MRFF, Medical Research Futures fund.