5.2 Amoxicillin and amoxicillin clavulanate dispensing, all ages

Increased antimicrobial use has prompted a number of policy and regulatory responses in Australia since publication of the first Atlas in 2015. Australia has taken a One Health approach, coordinating responses from all sectors that use antimicrobials. Responses have included:

• Development of Australia’s First National Antimicrobial Resistance Strategy, as part of a global response to combat AMR
• Development of the Antimicrobial Use and Resistance in Australia (AURA) Surveillance System by the Australian Commission on Safety and Quality in Health Care (the Commission) to inform strategies to prevent and contain AMR
• Establishment of the National Alert System for Critical Antimicrobial Resistance (CARAlert) by the Commission, as part of AURA, to collect close to real-time data on critical resistances to the last-line antimicrobials
• Establishment of the National Centre for Antimicrobial Stewardship, to promote the rational use of antimicrobials across Australia
• Implementation of antimicrobial stewardship programs in all health service organisations across Australia, under the requirements of the National Safety and Quality Health Service Standards
• Continued delivery of the NPS MedicineWise Resistance Fighter campaign (2012–2017) – a national initiative to help raise awareness of AMR and encourage reduction in antibiotic use where appropriate and safe to do so
• Letters from Australia’s Chief Medical Officer to general practitioners prescribing high amounts of antimicrobials, prompting audit of their antimicrobial prescribing practice to identify areas for quality improvement.

The Atlas found that, between 2013-14 and 2016-17, dispensing rates for amoxicillin fell. However, rates of amoxicillin-clavulanate dispensing did not fall in line with this. There has also been little change in the volume of either of these antimicrobials supplied on any given day in the Australian community, suggesting that there has been little change in the overall amount of use during the four years. Further efforts to improve use of these antibiotics and antimicrobial use more generally are needed.

Although amoxicillin dispensing rates fell in Australia between 2013–14 and 2016–17, rates for amoxicillin– clavulanate dispensing did not. The magnitude of variation in dispensing rates decreased for amoxicillin and increased for amoxicillin–clavulanate, which is unlikely to be explained by infection rates. Australia still has high volumes of use of both amoxicillin and amoxicillin–clavulanate. Further investigation is required to identify whether these patterns are warranted. Improving prescribing of these antimicrobials requires a sustained, multi-pronged approach. Australia’s first National Antimicrobial Resistance Strategy describes the collaborative efforts required to bring about practice change where appropriate, and to implement initiatives that support improvement in use in all settings of health care.

Download the Amoxicillin and amoxicillin clavulanate dispensing section of the Atlas below, to read more about the context, data, key findings, interpretation, and addressing of variation for this clinical item:

Content list:

• Context
• Why is it important to monitor antimicrobial use nationally? 
• What initiatives have taken place since 2015?
• About the data
• What do the data show?
  • Magnitude of variation
  • Rate of prescriptions dispensed
  • People dispensed at least one prescription
  • Volume of amoxicillin and amoxicillin–clavulanate use
• Interpretation
• Is there more to be done?