What is needed next: CRE-MARC. Three major obstacles remain to reducing antibiotic use in Australian primary care:
1) the poor adoption of several effective interventions for improving ARI prescribing, which emphasises that the next steps should be implementation research focussed on improving uptake of these interventions into practice;
2) the need to broaden the focus beyond minimising antibiotic use in just acute respiratory infections (ARIs) and to include the two other major antibiotic indications in primary care – skin and soft-tissue infections (SSTIs) and urinary tract infections (UTIs); and
3) the well-known, but little understood, problem of very high use of antibiotics in Residential Aged Care Facilities (RACFs).

What CRE-MARC is doing: There are 5 Research Streams:
1. Community Antibiotic Stewardship implementation studies with several Primary Healthcare Networks (PHNs) and Practice-Based Research Networks, culminating in a randomised trial of interventions known to be effective at reducing antibiotic prescribing;
2. Skin and soft-tissue infections (SSTIs) and urinary tract infections (UTIs) – generating and synthesising evidence about antibiotic benefits and harms for these conditions (which together with ARIs covers >85% indications for antibiotic use in primary care) and developing interventions to improve appropriateness of antibiotic use for them;
3. Residential Aged Care Facilities – tackling the problem of very high antibiotic use by exploring the reasons and using information about enablers and barriers to design interventions that improve the appropriateness of antibiotic use;
4. GP registrars – developing and evaluating targeted educational interventions; and
5. Addressing other important, but neglected, questions about antibiotic resistance by conducting both primary studies and systematic reviews of the literature.

Over-arching all these streams, CRE-MARC is strongly contributing to the training and development of a new set of researchers who are able to continue and lead research in this crucial area of population health concern, through training of PhD students, post-doctoral research fellows, and clinician-researchers.

Why CRE-MARC is needed