Respiratory-related antimicrobial prescribing ‘too high’: AURA 2023

The number of respiratory-related antimicrobial prescriptions still remains too high despite a recent decline, according to an analysis released by the Australian Commission on Safety and Quality in Health Care (ACSQHC).
 
In its newly published AURA 2023: Fifth Australian report on antimicrobial use and resistance in human health, the ACSQHC cites acute bronchitis, acute sinusitis, acute upper respiratory tract infections as conditions for which inappropriate prescribing takes place.
 
Others cited include influenza-like illnesses, acute otitis media, chronic obstructive pulmonary disease (COPD) and urinary tract infections (UTIs).
 
Supporting appropriate prescribing for these conditions is among the ACSQHC’s priorities to help reduce the rate of antimicrobial resistance, the report states – with the Commission outlining a plan to capitalise on a significant recent fall in prescribing rates.
 
Hundreds of people in Australia die each year due to drug-resistant infections, which are exacerbated by antimicrobials overuse, according to the ACSQHC. It says Australian community prescribing rates still outstrip most other countries.
 
In one example of questionable prescribing, the ACSQHC says there was no evidence of any clinical benefit in 80% of community-based antibiotic prescriptions for acute bronchitis.
 
Within hospitals, meanwhile, almost a quarter (23%) of antimicrobial prescriptions in 2022 were ‘inappropriate’, the report authors believe.
                                                                        
They also identify clostridioides difficile infection (CDI) as ‘a larger health concern in Australia than previously recognised’, with 80% of hospital patients with CDI having contracted the infection in the community.
 
The reports suggests that details on the diagnosis and management of CDI should be promoted on HealthPathways to support GPs and others working in primary care.
 
Pathogens including Staphylococcus aureus, Escherichia coli and Neisseria gonorrhoeae are also described in the report as becoming more resistant to major drug classes.
 
Improved antimicrobial prescribing in residential aged care, and better surveillance of sexually transmissible infections, as well as prevention and infection control programs, are among other priorities outlined by the ACSQHC.
 
Authors also warn about the challenges in tracking antimicrobial resistance for private prescriptions that are issued outside the PBS.
 
‘There are limited reporting and monitoring mechanisms in place for these prescriptions, which continues to be a gap in antimicrobial use surveillance in Australia,’ the report states.  
 
As previously reported by newsGP, antimicrobial prescribing rates remain lower than before the pandemic despite an increase in 2022 – a trend the report authors describe as ‘encouraging’.
 
They note that antimicrobial use in 2022, when there were around 21.8 million antimicrobials prescribed on the PBS, was 18% lower than in it was in 2019.
 
The reduction is partially attributed to the decrease in respiratory tract infections due to physical distancing measures introduced to minimise the spread of COVID-19.
 
A further policy change introduced in 2020 to limit repeat prescriptions of frequently prescribed antimicrobials also had an impact.
 
However, the report also points out that one in three Australians had at least one antibiotic dispensed in 2022, a rate higher than in many similar countries.
 
‘Australia ranks seventh highest compared with European countries, the United Kingdom and Canada in its use of antimicrobials in the community,’ the authors wrote.
 
They also estimated Australian hospital antimicrobial use as standing at nearly three times that of the Netherlands, which is the European country with the lowest antimicrobial use.
 
They wrote there is ‘room for improvement’ in Australia’s approach.  
 
Initial data for Australia was released within an ACSQHC technical report last month, ahead of the publication of the full AURA 2023 report, which is compiled every two years.
 
Professor John Turnidge, a Senior Medical Advisor for the Commission, noted the influence of general practice in reducing prescription rates and the importance of sustaining the changes.
 
‘COVID-19 had a major impact, as it was the first time the slow downward trend in antimicrobial prescribing was significantly accelerated with the help of GPs, who did not prescribe as many antibiotics,’ he said.
 
‘We have an opportunity to build on this achievement to tackle one of the most serious health challenges of our time.
 
‘Let’s all think twice before automatically prescribing and using antibiotics – or having them “just in case”. 
 
‘If we don’t, in the future we may not be able to perform medical procedures such as organ transplants, cancer chemotherapy, diabetes management and major surgery. That is a bleak future that none of us wish to contemplate.’
 
The World Health Organization (WHO) has described antimicrobial resistance as one of the top 10 most significant global public health threats facing humanity, predicting it could cause up 10 million deaths annually by 2050 in a worst-case scenario.
 
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