High rates of skin infections in early life are driving high rates of antibiotic use in kids living in remote Aboriginal communities.

In the Northern Territory’s East Arnhem region 95% of children had received at least one antibiotic prescription by their first birthday, according to a study that reviewed medical records of 400 children in five remote Aboriginal communities.

Antibiotic use is being driven by the high endemic prevalence of skin conditions such as Group A Streptococcus (GAS) skin sores in remote Indigenous communities, according to researchers writing in the Australia and NZ Journal of Public Health. In their study they found the monthly prevalence of skin infections (skin sores, scabies, fungal) was 20% (range: 12–34%).

Researchers at the Peter Doherty Institute for Infection and Immunity (Doherty Institute) and Menzies School of Health Research (Menzies) said that eliminating skin disease could reduce antibiotic use by almost 20% in children under five years of age in this population.

Lead author Associate Professor Steven Tong, Clinician Researcher at the Doherty Institute and Royal Melbourne Hospital said recent research showed rates of MRSA of up to 60% in Aboriginal communities compared to only around 15% in the general population.

“What we have found in this study is that there are a lot of childhood infections in this population – ear, skin and respiratory – that require antibiotics, and heavy antibiotic use can drive antibiotic resistance,” he said.

But inappropriate prescribing of antibiotic use was not as big a problem in Aboriginal communities as it was in urban settings, Professor Tong emphasised.

“In suburban Melbourne, GPs are encouraged to limit prescribing antibiotics for minor infections of the ear or respiratory tract, usually caused by viruses. Almost always, antibiotics being prescribed in Indigenous communities are appropriate, because ultimately, if you don’t treat these bacterial infections, there may be complications,” he said.

“It comes back to prevention and advocating for improvements in housing, access to working hygiene hardware like washing machines, and health literacy.”

The research team estimated that if preventative efforts reduced the number of skin infections, antibiotic use could be reduced by up to 20%.

Associate Professor Tong, who is also a Principal Research Fellow at Menzies School of Health Research, said when the communities asked researchers to work with them more than 15 years ago, there was a realisation that the burden of infections was high.

“Unfortunately, infections are just as common now as they were when we began collecting the data, and we are seeing the downstream impact of using lots of antibiotics with rising rates of antibiotic resistance,” Associate Professor Tong said.

“Unless there are greater prevention efforts, we are likely to see just as many infections, but with the complication that they are harder to treat because of antibiotic resistance.”