Prescribing of respiratory-related antibacterial drugs is “too high”: AURA 2023
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According to the ACSQHC, hundreds of Australians die every year from drug-resistant infections exacerbated by the overuse of antimicrobials.
Antimicrobial prescribing via PBS has failed in Australia, but rates remain higher than in many similar countries.
Despite recent declines, the number of respiratory-related antimicrobial prescriptions remains too high, according to analysis released by the Australian Council for Safety and Quality in Healthcare (ACSQHC).
in its newly published Halo 2023: Australia’s fifth report on antimicrobial use and resistance in human healthACSQHC lists acute bronchitis, acute sinusitis, and acute upper respiratory tract infection as conditions for which prescribing is inappropriate.
Other illnesses mentioned include influenza-like illness, acute otitis media, chronic obstructive pulmonary disease (COPD) and urinary tract infection (UTI).
The report notes that supporting appropriate prescribing for these conditions is one of ACSQHC’s priorities to help reduce the incidence of antimicrobial resistance, and the committee outlines a plan to capitalize on recent major failures in prescribing rates.
According to the ACSQHC, hundreds of people die every year in Australia from drug-resistant infections, which are exacerbated by overuse of antimicrobials. Prescribing rates in the Australian community remain higher than in most other countries, the report said.
In one example of questionable prescribing, the ACSQHC said there was no evidence that 80 per cent of community antibiotic prescriptions for acute bronchitis had any clinical benefit.
Meanwhile, within hospitals, nearly a quarter (23%) of antimicrobial prescriptions in 2022 were “inappropriate”, the report authors believe.
They are also sure Clostridium difficile
infection (CDI) is considered “a more serious health problem in Australia than previously recognized”, with 80% of hospital-based CDI patients acquiring the infection in the community.
The report recommends that detailed information on the diagnosis and management of CDI should be publicized on HealthPathways to support GPs and other primary care staff.
Pathogens include Staphylococcus aureus, Escherichia coli and Neisseria gonorrhoeae It was also described in the report as becoming more resistant to major drug classes.
Other priorities outlined by the ACSQHC include improved antimicrobial prescribing in residential aged care, better surveillance of sexually transmitted infections and prevention and infection control programmes.
The authors also warn of challenges in tracking antimicrobial resistance in private prescriptions issued outside the PBS.
“Limited reporting and monitoring mechanisms for these prescriptions remain a gap in the surveillance of antimicrobial use in Australia,” the report states.
As previously reported NewsGPDespite an increase in antimicrobial prescription rates in 2022, antimicrobial prescription rates remain lower than before the pandemic — a trend the report authors called “encouraging.”
They noted that antimicrobial use in 2022 was 18% lower than in 2019, when approximately 21.8 million antimicrobials were prescribed on the PBS.
Part of this decrease is due to fewer respiratory infections due to physical distancing measures put in place to minimize the spread of COVID-19.
Further policy changes introduced in 2020, which aim to limit the repeat prescribing of commonly used antimicrobials, have also had an impact.
However, the report also states that one in three Australians will be dispensed at least one antibiotic by 2022, a higher proportion than in many similar countries.
“Australia ranks seventh in community antimicrobial use compared with European countries, the UK and Canada,” the authors wrote.
They also estimate that antimicrobial use in Australian hospitals is almost three times that of the European country with the lowest antimicrobial use in hospitals, the Netherlands.
They wrote that there was “room for improvement” in Australia’s approach.
Preliminary data for Australia was released in an ACSQHC technical report last month, with the full AURA 2023 report subsequently produced every two years.
Professor John Turnage, the committee’s senior medical adviser, noted the impact of general practice in reducing prescribing rates and the importance of sustaining this change.
“COVID-19 has had a significant impact because for the first time, the slow decline in antibiotic prescribing has accelerated significantly with the help of GPs, who are not prescribing as many antibiotics,” he said.
“We have an opportunity to build on this achievement and tackle one of the greatest health challenges of our time.
“Let us all think twice before automatically prescribing and using antibiotics, or before using them ‘just in case’.
“If we don’t do this, in the future we may be unable to perform medical procedures such as organ transplants, cancer chemotherapy, diabetes treatments and major surgeries.” This is a bleak future that none of us wants to consider.
The World Health Organization (WHO) describes antimicrobial resistance as one of the top ten global public health threats facing humanity and predicts that in the worst-case scenario, antimicrobial resistance could kill up to 10 million people annually by 2050 die.
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