Therapeutics

Te Whata Kura - a national antibiotic guideline for Aotearoa

Antibiotics are underused in some patients in whom they would provide benefit and overused in others who could be harmed by unnecessary treatment. A core goal of antimicrobial stewardship (AMS) is to slow development of antibiotic resistance, which can also be thought of as antibiotic conservation – using antibiotics as well as we can to ensure these important medicines remain available and effective for our tamariki and mokopuna.

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Principal Investigator

Dr Stephen Ritchie, Dr Karen Wright, Dr Lily Fraser

University of Auckland and Turuki Healthcare

Public Contact

teniwhacomms@otago.ac.nz

Project Status

Completed

Funding

$1,788,950.00

Whakarāpopoto Rangahau Summary of Research

The Problem

At present there is no standard to both guide antibiotic prescribing and measure the appropriateness of treatment. While we know there are marked inequities in the rates of infections for Māori and Pacific peoples in Aotearoa, very little is known about the inequities in infection treatment.

Our Solution

We plan to develop a national antibiotic guideline in Aotearoa that sets out the optimal treatment of infections.

We will also develop innovative systems that automatically monitor antibiotic prescribing together with the reasons for prescribing antibiotics, and information about the populations for whom antibiotics were prescribed.

Using our new guideline and monitoring system, we will then determine the appropriateness of antibiotic prescribing for important infectious diseases in Aotearoa (e.g. sore throats, skin infections, meningitis), with particular attention to prescribing for Māori, Pacific peoples and other population groups who bear a disproportionate burden of infectious disease in Aotearoa.

Finally, we will work collaboratively with Māori health providers, and with hospital and community-based clinicians to determine how best to provide prescriber feedback about antibiotic prescribing and will assess the impact of feedback on prescribing practice. Our partnership with Te Niwha will provide the foundation for improving antibiotic use in Aotearoa. Improving antibiotic use via antimicrobial stewardship efforts in Aotearoa is critical to reducing the threat of antibiotic resistance, reducing harm, enhancing equitable care, and improving patient outcomes.

PROJECT DURATION 2023 - 2026

Research Location

Auckland, Christchurch, Wellington, Dunedin

L-R (back row): Dr Stephen Ritchie, Eamon Duffy, Dr Max Bloomfield, Dr Tom Hills
L-R (front row): Dr Sharon Gardiner, Dr Sarah Metcalf, Dr Emma Best

L-R: Leanne Te Karu, Dr Lily Fraser, Dr Karen Wright

Te Hiranga a Rangahau Research Impact

Many public hospitals are not adequately resourced to provide AMS services, and AMS services are urgently needed in primary care. The outputs of our project will be available to all public hospitals and all primary care providers in Aotearoa and will make huge advances towards ensuring that all clinicians have access to appropriate AMS advice.

The innovative outputs of the project will provide Aotearoa with the best AMS systems in the world. The impact of the project will be measured in the first instance by: (i) the frequency with which the new guidelines are viewed by prescribers in primary and secondary care, (ii) the magnitude of annual reductions in inappropriate antibiotic prescribing, and (iii) the magnitude of increases in guideline adherent antibiotic prescribing, all of which can be measured within the timescale of the project.

In the longer term, the impact of the project will be measured by whether the quality of antibiotic prescribing demonstrates sustained improvement, the impact of infectious diseases on the people of Aotearoa declines, and the spread of antibiotic resistant bacteria is reduced. We are confident that the opportunity provided by this work with Te Niwha will not only improve the health of New Zealanders and also slow the development of antimicrobial resistance.

An important impact of the project will be the creation of new collaborative relationships between people with varied roles and working in many different organisations, all of whom are determined to improve the care provided for people with infections in Aotearoa. We hope that these new relationships will be the base for ongoing research collaborations to further this work in the years ahead.

>> IMPACT CASE STUDY (PDF) December 2025

Project Outputs

PUBLICATION

>> Nurses ‘under-used in antimicrobial stewardship’
Authors: G. Lim, S. Gardiner and S. Ritchie

MEDIA RELEASE

>> New tech to help doctors reduce risks from antibiotic resistance crisis (RNZ News)

>> New Guidelines to Combat Drug-Resistant Infections (Te Hiku Media)

>> Tackling antimicrobial resistance: It starts with us (GP Voice - Page 31)

Ngā Pourangahau Research Leaders

Dr Stephen Ritchie
University of Auckland
Academic Infectious disease physician

Dr Karen Wright
Kāi Tahu
Te Kupenga Hauora Māori,
University of Auckland
Public Health Physician

Kairangahau Research Personnel

Dr Lily Fraser Kāi Tahu Turuki Healthcare GP
Dr Emma Best University of Auckland Academic Paediatric Infectious disease physician
Dr Maxim Bloomfield Te Whatu Ora, Capital Coast and Hutt Valley Microbiologist and Infectious disease physician
Professor Stephen Chambers University of Otago Academic Infectious disease physician
Eamon Duffy Te Whatu Ora, Te Toka Tumai Antimicrobial Stewardship Pharmacist
Dr Sharon Gardiner Te Whatu Ora Waitaha Antimicrobial Stewardship Pharmacist
Dr Tom Hills Te Whatu Ora, Counties Manukau Academic Infectious disease physician

Dr Gigi Lim Academic Registered Nurse
Dr Sarah Metcalf Te Whatu Ora Waitaha Infectious disease physician
Leanne Te Karu Ngāti Rangi, Te Ati Haunui-a-Pāpārangi, Muaūpoko Pharmacist prescriber
Associate Professor Alesha Smith University of Otago Academic Pharmacist
Associate Professor Mark Thomas University of Auckland Academic Infectious disease physician
Elaine Umali NIHI, Auckland UniServices Ltd Key Researcher - Project Manager
Chelsey Gardiner NIHI, Auckland UniServices Ltd Key Researcher - Project Coordinator