‘We are moving in the right direction but have more work to do.’

A new report reveals consistent decline in antimicrobial consumption in Australia, but volume of use is still more than double that of comparable OECD countries

The Australian Commission on Safety and Quality in Health Care examined 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.

It found a downward trend in the number of prescriptions, rate of prescriptions dispensed and volume of use (number of defined daily doses dispensed per 1,000 people per day) for all three medicines items.

For example, 28.2 million PBS/RPBS prescriptions for antimicrobial medicines were dispensed in 2017–18 compared with 30.3 million prescriptions in 2013–14.

There was also a decrease in volume of antimicrobial medicines supplied on any given day in the Australian community, down by 4% over the most recent three years.

The rate of antimicrobial medicines dispensing in Australia per 100,000 declined from 126,864 in 2013-14, to 109,965 in 2017-18. In the same time frame, the amoxicillin dispensing rate decreased from 24,112 per 100,000 to 20,699. The amoxicillin-clavulanate dispensing rate declined from 19,110 to 17,910.

However Australia’s antimicrobial prescription rate remains high by international standards. In 2017–18, there were 22.7 defined daily doses of antimicrobial medicines dispensed for every 1,000 Australians per day. This is more than double the equivalent figure in the Netherlands and Sweden, which is 8.9 and 10.8, respectively.

“It is significant that we are witnessing the first evidence of a consistent decline in antimicrobial consumption in Australia since the last decline in 2003,” said Professor John Turnidge AO, the Commission’s Senior Medical Advisor.

“We are moving in the right direction but have more work to do, as the volume of antimicrobial use is still more than double that of comparable OECD countries.

“Focusing on reduced prescribing in areas where there is high use will help to drive down our national antimicrobials consumption,” he said.

The Commission’s analysis identified areas with consistently high antimicrobial dispensing rates included Mount Druitt, St Marys and Fairfield in New South Wales; Ipswich Inner, Beenleigh and Browns Plains in Queensland; and Sunbury and Tullamarine-Broadmeadows in Victoria.

Three quarters of the areas with consistently high use (73%) were in the lowest quintile of socioeconomic status. However even in these consistently high dispensing areas, the trend was downward from 2014–2015.

Antimicrobial rates for Western Australia, South Australia, Tasmania, the Australian Capital Territory and Northern Territory were consistently lower than the national rate over the five-year period.

“The findings show a downward shift in prescribing in most areas, which is encouraging, but not at the pace needed in some,” said Professor Turnidge.

“We have made progress at a national level, but it is clear that more can be done in many areas to ensure that antimicrobials are prescribed only when necessary.

“Factors influencing consistently high rates in the most disadvantaged areas need further exploration. They may include higher rates of infectious diseases and socioeconomic characteristics, such as lower education levels, which may lead to increased likelihood to self-medicate with leftover or shared antimicrobials,” he said.

The overall national decline in antimicrobial consumption may provide some evidence that the message about unnecessary use is reaching prescribers and the public, the Commission suggested.

Lower dispensing rates in Northern Territory most likely reflect an alternate source of dispensing to PBS/RPBS, for example Aboriginal health services, and results for this region should be interpreted with caution, it added.

View the full report here

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