Antimicrobial medicines dispensing from 2013–14 to 2017–18

Australia has a higher rate of antimicrobial medicines use than many other OECD countries.[1] Monitoring use and reducing unnecessary antibiotic prescribing is a key strategy for preventing and containing antimicrobial resistance (AMR). AMR reduces the range of antimicrobial medicines available to treat infections and increases the morbidity and mortality of multi-drug resistant infections. 

This report examines Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme (PBS/RPBS) prescriptions dispensing for people of all ages, from 2013–14 to 2017–18, for three medicines items:

• antimicrobial medicines
• amoxicillin, and
• amoxicillin-clavulanate

Data are reported according to where people live. The report presents national data, and data by state and territory, PHN and small geographical area [Statistical Area Level–3; SA3].

The report is divided into three interactive summaries:

• National, state and territory trends
• PHN trends
• Patient rate and DDD rate 

Scroll to the bottom of the graphs to select indicators, states, SA3s, PHNs or measures (see drop down boxes). There are also Notes to help with data interpretation at the bottom of each graph.

The report builds on the findings of the Australian Atlas of Healthcare Variation series. The Third Atlas 2018 examined antimicrobial medicines dispensing at a national level from 2013–14 to 2016–17.

This report complements AURA 2019: Third Australian report on antimicrobial use and resistance in human health. The AURA report provides a comprehensive picture of antimicrobial resistance (AMR), antimicrobial use and the appropriateness of antimicrobial prescribing in Australia, in hospitals, aged care, general practice and the community.

Data are sourced from the PBS dataset. This dataset includes all prescriptions dispensed under the PBS or the RPBS, including prescriptions that do not receive an Australian Government subsidy. Not all dispensed medicines may be consumed by patients.

The dataset does not include prescriptions dispensed for patients during their hospitalisation in public hospitals, discharge prescriptions dispensed from public hospitals in New South Wales and the Australian Capital Territory, direct supply of medicines to remote Aboriginal health services, over-the-counter purchase of medicines, doctor’s bag medicines and private prescriptions.

This analysis was not undertaken by Aboriginal and Torres Strait Islander status because this information was not available for PBS data at the time of publication.

Changes have been made to the data specification used in the first Atlas to improve the robustness of comparing rates over time. The main change is the addition of sex standardisation, as the data specification for the first Atlas standardised for age only. These changes have resulted in small differences in the rates reported for 2013–14 in the first Atlas and this report. The rates in this report should be used to monitor changes over time.

• Data from 2017–18 confirm the downward trend in antimicrobial medicines use in the Australian community, but use remains higher than for comparable OECD countries.
• The downward trend was seen in the number of prescriptions, the rate of prescriptions dispensed and in the volume of use (number of defined daily doses dispensed per 1,000 people per day) for all three medicines items. 28.2 million PBS/RPBS prescriptions for antimicrobial medicines were dispensed in 2017–18 compared with 30.3 million prescriptions in 2013–14. 
• 22.7 defined daily doses of antimicrobial medicines were dispensed for every 1,000 Australians per day in 2017–18. This is more than double the equivalent figure in the Netherlands and Sweden, 8.9 and 10.8, respectively [2]. 
• Excluding the Northern Territory, dispensing rates for all three items were similar across all states and territories in 2017–18, although Western Australia (WA), Australian Capital Territory and Tasmanian rates were about 10% lower than the other four states and territories.
• The lower rates in WA are particularly prominent when metropolitan Primary Health Networks (PHNs) are compared. Perth North and Perth South PHNs have amongst the lowest dispensing rates in metropolitan Australia. The reasons for these lower rates need to be explored.
• Rates were similar across most categories of remoteness in 2017–18, but were significantly lower in remote areas. Variation could be due to a range of factors such as alternative (non-PBS) access to antimicrobial medicines (e.g. through Aboriginal health services), limited access to health care services more generally or cost factors.
• Socio-economic status (SES) of area in which people lived also influenced dispensing rates to a small extent with the exception of remote areas. Small geographical area (Statistical Area Level–3; SA3) areas in the lower SES quintiles (more disadvantaged) had higher dispensing rates. The average rate in areas in the first quintile (most disadvantaged) was about 116,000 per 100,000 people, while the rate in the fifth quintile was about 103,000 per 100,000 people.  

• We are witnessing the first evidence of a consistent decline in antimicrobial consumption in Australia since the last decline in 2003.[3] However, the volume of antimicrobial use (DDD per 100,000 people per day) is still more than two-fold that of benchmark countries with similar demographic profiles and standards of healthcare.
• This trend is observed with total antimicrobial medicines use, as well as with use of amoxicillin and amoxicillin–clavulanate, the second and third most widely prescribed antimicrobials in the community in 2018 [4]. This is consistent with the AURA 2019 findings on antimicrobial medicine use in the community [4].
• The trend is in all areas, across all states and territories, which provides at least indirect evidence that the message about unnecessary use is reaching the prescribers and the public. Results are consistent with the hypothesis of improved population health literacy and increased awareness of appropriate prescribing by providers.
• Almost all of the consistently high dispensing areas were in New South Wales, Victoria and Queensland, although even in these areas the trend was downward from 2014–2015.
• The lower dispensing rates in Northern Territory most likely reflect an alternate source of dispensing to PBS/RPBS (Aboriginal health services) and results should be interpreted with caution.
• Contextual interpretation of results in other low dispensing rate areas is required – areas of high socioeconomic status and areas of chronic doctor shortage (rural and remote locations) reflect very different reasons for lower dispensing rates. 
• Strategies for Antimicrobial Stewardship (AMS) including education in primary care, the National Safety and Quality Health Service Standards for AMS [5] and NPS MedicineWise. Education [6,7] may have contributed to the downward trends through increased awareness of appropriate prescribing.

• In order to reduce antimicrobial resistance and optimise rates of appropriate use in Australia to those of benchmark countries; educational efforts and direct audit and feedback need to be considered, continued or increased. Experience in other countries has shown that educational efforts must be sustained over years to ensure lasting improvements in prescribing.
• Actions to improve appropriate use of antimicrobial medicines must not compound existing health inequities. Contextual interpretation of results is required; two groups in the lowest dispensing areas – areas of high socioeconomic status and areas of chronic doctor shortage (rural and remote locations) reflect very different reasons for lower dispensing rates. 
• Dissemination of guidelines for prescribing for particular conditions, for example the continuum of upper respiratory tract infection (URTI) symptoms, which may have a viral or bacterial outcome, may also improve appropriateness of prescribing antimicrobial medicines.
• Research to explore certain sectors such as metropolitan Perth may provide insights as to how strategies may be targeted to achieve improvements.
• In parallel with educational efforts, a re-setting of levels of access on the PBS/RPBS would likely assist in improving appropriateness of use in the Australian community.

1. OECD. Health at a glance 2019; chapter 6; overall volume of antibiotics prescribed, 2017
2. European Centre for Disease Prevention and Control. Antimicrobial consumption in the EU/EEA, annual epidemiological report for 2018. Stockholm; ECDC; 2019.
3. Australian Commission on Safety and Quality in Health Care (ACSQHC). AURA 2019: third Australian report on antimicrobial use and resistance in human health. Sydney: ACSQHC; 2019.
4. Australian Commission on Safety and Quality in Health Care (ACSQHC). AURA 2017: second Australian report on antimicrobial use and resistance in human health. Sydney: ACSQHC; 2017.
5. Australian Commission on Safety and Quality in Health Care (ACSQHC). Clinical governance and quality improvement to prevent and control healthcare-associated infections, and support antimicrobial stewardship.2017.
6. Turnidge J. Antimicrobial use and resistance in Australia. NPS MedicineWise. Aust Prescr 2017; 40:2-3
7. NPS MedicineWise. Antibiotics, explained. 18 Dec 2019.

The graphs are interactive. Hover mouse over the graph labels for more details.  Hover mouse over graphs to inspect rates.

Scroll to the bottom of the graphs to select indicators, states, SA3s, PHNs or measures (see drop down boxes).

See link to Notes at the bottom of the graphs for help with data interpretation.