Putting a lid on antibiotic prescribing


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The Department of Health is considering restrictions on doctor prescribing of antibiotic repeats

The Federal health department has undertaken a review of listings for the top five antibiotics prescribed with repeats on the PBS, and where appropriate proposed changes for consideration by the Pharmaceutical Benefits Advisory Committee (PBAC) later this year, a departmental spokesperson has confirmed to the AJP.

“The proposed changes are aimed at supporting health professionals to engage in antimicrobial stewardship and prescribe antibiotic repeats only when clinically indicated, thus reducing inadvertent repeat prescribing when initiating a course of antibiotics,” said the Department of Health spokesperson.

“The proposed changes only relate to antibiotics prescribed on the PBS and are not intended to impede health professionals’ ability to prescribe antibiotic repeats when clinically indicated,” said the spokesperson.

“Where restrictions have been proposed, other mechanisms for prescribing repeats will still be available to prescribers, such as through phone authority or private prescription.”

Data from 2017 shows about half of all antibiotic prescriptions were ordered with repeats, and approximately half were filled within 10 days of the original prescription.

Repeat prescriptions filled within 10 days usually indicate a continuation of the original course of treatment, while those dispensed after 10 days may indicate interruption of the original duration and increased potential for inappropriate use.

In late 2018, the Department of Health provided a consultation paper with the proposed changes to individual antibiotic listings to key stakeholders including the PSA, Pharmacy Guild, AMA and RACGP for consideration.

On 7 June 2019, consultation commenced with relevant sponsors to seek their feedback on the proposed changes, which will be taken into consideration during further PBAC deliberations later this year.

Research by NPS MedicineWise in 2014 showed that patient expectations lead many general practitioners to prescribe antibiotics when they may not be effective—contributing to the growing problem of antibiotic resistance.

It found more than half of GPs (57%) reported that they would prescribe antibiotics for an upper respiratory tract infection to meet patient expectations.

One fifth (20%) of surveyed consumers said they would expect the doctor to prescribe antibiotics for a cold or flu, while 17% of surveyed consumers would ask a doctor to prescribe antibiotics.

“Some doctors don’t believe their individual prescribing makes a difference, and some patients believe antibiotic resistance is an issue for future generations and therefore they won’t bear the consequences,” said NPS MedicineWise.

A review of PBS/RPBS data by the Antimicrobial Use and Resistance in Australia (AURA) project found that in 2017:

  • 41.5% (n = 10,215,109) of the Australian population had at least one systemic antibiotic dispensed under the Pharmaceutical Benefits Scheme (PBS) or the Repatriation Pharmaceutical Benefits Scheme (RPBS).
  • The mostly commonly supplied antibiotics under the PBS/RPBS continue to be cefalexin, amoxicillin and amoxicillin–clavulanic acid.
  • Approximately 50% of all antibiotic prescriptions were ordered with repeats; of those repeats, approximately half were filled within 10 days of the original prescription.

However after a steady increase in the rate of antibiotic dispensing under the PBS/RPBS between 2013 and 2015, there was a decline in 2016, and a further decline in 2017.

This is the first downward trend in community antibiotic dispensing since the late 1990s, said the AURA report.

“Although these trends are encouraging, the high rates of antibiotic use in Australia remain a serious public health issue,” said the report.

“Australia remains in the top 25% of countries with the highest community antibiotic use, compared with European countries and Canada.”

Associate Professor Louis Roller, from the Faculty of Pharmacy and Pharmaceutical Sciences Monash University, says pharmacists can educate the public to help prevent antibiotic resistance by:

  • Understanding that most people don’t need antibiotics for colds and flu because they are caused by viruses.
  • Asking for an antibiotic only if it is really necessary.
  • Taking the right dose of the antibiotic at the right time, as prescribed.
  • Taking antibiotics for as long as the prescriber says.
  • Avoid infections and prevent them from spreading.

Public consultation on the next AMR Strategy is open from 7 June 2019 to 28 June 2019. Please visit: https://consultations.health.gov.au/

See more resources for pharmacists here

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