Key Findings
Australia has very high overall rates of community antimicrobial use compared with some countries. In 2013–14, more than 30 million prescriptions for antimicrobials were dispensed. Many of these were unnecessary because antimicrobials are frequently used to treat infections for which they provide little or no benefit. The rate of total antimicrobial dispensing was over 11 times more in the area with the highest rate compared to the area with the lowest rate. High community use of antimicrobials increases the risk that bacteria will become resistant to these medicines and they will cease to be effective against serious life-threatening conditions. Even when the areas with highest and lowest rates were excluded, the rate was nearly twice as high in some parts of Australia than others. Western Australia appears to be much more successful than other parts of the country in keeping rates of antimicrobial dispensing relatively low – the highest rate for any area in Western Australia was lower than the Australian average rate.
Use of a specific class of antimicrobials called quinolones was low compared with other countries because their use is restricted in Australia. Nevertheless, more than 350,000 prescriptions were dispensed for these antimicrobials in 2013–14, and considerable variation was seen across Australia. The rates of quinolone dispensing were over 8 times more in the area with the highest rate compared to the area with the lowest rate. Even when the areas with the highest and lowest rates were excluded, rates of dispensing of quinolones were over 2.5 times more in some areas of Australia than in others.
There was variation in dispensing across the country for amoxycillin, the most commonly dispensed antimicrobial in Australia, and for amoxycillin-clavulanate, a modified version of amoxycillin. Combined, these two antimicrobials accounted for more than 10 million prescriptions dispensed under the Pharmaceutical Benefits Scheme (PBS) in Australia in 2013–14. The rates of amoxycillin dispensing were 20.5 times more in the area with the highest rate compared with the area with the lowest rate, and 2.7 times when the highest and lowest rates were excluded. The rates of amoxycillin-clavulanate dispensing were 16 times more in the area with the highest rate compared with the area with the lowest rate, and 2.2 times when the highest and lowest rates were excluded.
Recommendations
1a. The Australian Government Department of Health develops national benchmarks for best practice prescribing of antimicrobial agents. Findings from the Atlas should be used to identify variations from these benchmarks and target interventions to reduce inappropriate use.
1b. The Pharmaceutical Benefits Advisory Committee examines the use of topical quinolones and access to amoxycillin-clavulanate on the PBS.
1c. Antimicrobial stewardship programs are implemented in general practice in line with recommendations in the National Antimicrobial Resistance Strategy to reduce the use of amoxycillin and amoxycillin-clavulanate.
1d. The relevant clinical colleges support incorporation of decision support software in prescribing software, and review the current default repeat prescriptions option.
1e. Primary health networks and local health networks track and compare antimicrobial prescribing rates where they do not do so already.
1f. National boards and the Australian Health Practitioner Regulation Agency consider what can be done to ensure relevant registered health practitioners have up-to-date knowledge of prescribing guidelines for antimicrobials.