Cook Islands rate low in antibiotic resistance

Wednesday February 28, 2018 Written by Published in Health
New Zealand infectious disease specialist and microbiologist Dr Richard Everts (left) with Rarotonga hospital chief microbiologist Geoffrey Wuatai working on a sample for antibiotic resistance. 18022710 New Zealand infectious disease specialist and microbiologist Dr Richard Everts (left) with Rarotonga hospital chief microbiologist Geoffrey Wuatai working on a sample for antibiotic resistance. 18022710

Antibiotic resistance is increasing all around the Pacific Islands, but in the Cook Islands it is not a problem yet.


According to  research led by Doctor Richard Everts, a New Zealand infectious disease specialist and microbiologist, Cook Islands is one of the countries in the region which is least resistant to antibiotics.

This means that most of the antibiotics that the Cook Islanders use for treatment of infections are safe and effective.

“We measure the resistance to antibiotics and we monitor it year by year and in some countries in the Pacific, especially Samoa and Tonga, the resistance is building up very quickly. That means you can’t use antibiotics very well because they are not very effective anymore,” Dr Everts said. “In the Cook Islands, I’m very pleased to say that over the last five to six years, the level of resistance (to antibiotics) has stayed about the same.”

Antibiotics are medicines that kill bacteria and stop infections, which is a very common reason for people to visit the Emergency Department at Rarotonga Hospital.

Without antibiotics, doctors would not be able to perform surgery safely, care for people in intensive care, or give cancer chemotherapy.  Dr Everts said antibiotics save the lives of many Cook Islands people with infections each year, including both adults and children. 

“Between 550 and 800 antibiotic prescriptions every month are supplied to patients by the Cook Islands Ministry of Health,” he said.

“In addition to this, antibiotic prescriptions are also supplied to patients by private pharmacies in Rarotonga.”

Dr Everts explained resistance is when the bacteria are no longer killed by an antibiotic. 

He said bacteria becomes resistant by mutation before spreading from person to person.  Resistance is tested in the microbiology laboratories at Rarotonga Hospital and Aitutaki Hospital.  Recent tests have revealed that in the Cook Islands, Staphylococcus aureus which is a bacterium that causes skin, joint, bone and blood infections, is still mostly vulnerable to antibiotic flucloxacillin.

In the last several years, between 85 per cent and 92 per cent of Staphylococcus aureus were susceptible to flucloxacillin. “In summary, antibiotic resistance is developing rapidly in other Pacific Islands but not in the Cook Islands, with the exception of amoxicillin and Augmentin resistance in E. coli,” Dr Everts said. “Reasons for this low rate of antibiotic resistance may include the lower total population in the Cook Islands and the lower household occupancy in the Cook Islands (average 3.5 persons/house), compared with some other Pacific Islands (Samoa population of about 200,000, household occupancy average 8.3 persons/house, Tonga’s population is more than 100,000, 6.8-7.1).”

Improved standard of living and better education on healthy living could also be reasons for a low rate of antibiotic resistance in the Cook Islands. Dr Everts, whose work has been funded through the World Health Organisation, made six visits to the Cook Islands since 2015 to support the microbiology laboratory and guide antibiotic prescribing. He conducted a lot of research on infections and antibiotic resistance in the country with help of Rarotonga Hospital laboratory scientists Geoffrey Wuatai and Peia Ben.

“Laboratory results show us the bacteria that cause infections in the Cook Islands and the best antibiotics. This information has been used to write infection guidelines for doctors, nurses and pharmacists in the Cook Islands,” Dr Everts said.

“The guidelines include recommendations on which antibiotics are best for treatment of infection and prevention of infection.  “The guidelines also include instructions on the best dose of antibiotics to give each patient, including children and over-weight patients, and alternative antibiotics to prescribe when the usual ones are unavailable.”- RK

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