Survey identifies opportunities to improve appropriate use of antibiotics in Australian hospitals

In 2017, around one-third of prescriptions for antimicrobials in participating Australian hospitals were assessed as not compliant with treatment guidelines. Almost 1 in 4 antimicrobial prescriptions were assessed as inappropriate.

The findings come in a report, Antimicrobial prescribing practice in Australian hospitals: Results of the 2017 Hospital National Antimicrobial Prescribing Survey, released today by the Australian Commission on Safety and Quality in Health Care (the Commission).

The Hospital National Antimicrobial Prescribing Survey (Hospital NAPS) is an annual survey of antimicrobial prescribing in Australian hospitals conducted by the National Centre for Antimicrobial Stewardship (NCAS), as part of the Antimicrobial Use and Resistance in Australia (AURA) Surveillance System. The NAPS was developed to provide a detailed assessment of antimicrobial prescribing practices and to support national comparisons.

Resistance to antibiotics and other antimicrobials is recognised worldwide as a critical threat to public health. This report coincides with the global campaign for Antibiotic Awareness Week (12-18 November), endorsed by the World Health Organization (WHO), which encourages everyone to play a role in tackling antibiotic resistance.

Dr Kathryn Daveson, Clinical Director of the AURA Program at the Commission, said: “Overuse and inappropriate use of antimicrobials is a key factor contributing to bacteria and other pathogens becoming unresponsive to last-line drugs.

“These results are hugely concerning as ongoing inappropriate use of antibiotics assists bacteria to evolve increased resistance to existing antibiotics. This misuse places a heavy burden across the population, with a disproportionate impact on vulnerable communities, such as aged-care residents and people in rural and remote areas.

“Clinicians are already seeing the impact of antimicrobial resistance, with increasing challenges in treating people for common illnesses. Ultimately, we may lose the effectiveness of antibiotics to keep us healthy when we most need them,” said Dr Daveson.

The 2017 report summarises the results of a voluntary audit of 314 hospitals (228 public and 86 private) from across Australia, and analysis of 26,277 prescriptions for 17,366 patients.

Participating hospitals assess the prevalence and appropriateness of antimicrobial prescribing, and compliance with guidelines at a local level, and are able to compare their results to other like hospitals.

The 2017 results show:

  • Overall, almost one quarter (23.5%) of prescriptions were assessed as inappropriate. Almost one third (32.7%) were non-compliant with guidelines
  • Inappropriate use was related to factors such as unnecessary use of broad-spectrum antimicrobials and incorrect duration of treatment
  • Inappropriate prescribing was common for patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) (37.8% of prescriptions were assessed as inappropriate); this is an overall improvement since 2013, when 46% of prescribing for COPD was inappropriate
  • Overall, surgical prophylaxis was the most common reason for antimicrobial prescriptions in hospitals, and for almost one third (30.5%) of cases, it was inappropriately given for more than 24 hours
  • Just over three quarters (77.7%) of antibiotic prescriptions had a reason for prescribing documented in the medical notes, which is an overall improvement compared to 2013 when only 70.9% of prescriptions had an indication recorded.

Antimicrobial stewardship refers to efforts aimed at promoting responsible use of antimicrobial drugs, including antibiotics and antifungals, and is a clinical priority in the response to increasing rates of drug-resistant infections.

Associate Professor Kirsty Buising, Deputy Director of NCAS, said: “Hospital NAPS enables participating hospitals to identify clinical areas where antimicrobial stewardship could be improved such as surgical antimicrobial prophylaxis – antimicrobial use for the prevention of surgical site infections – and the treatment of respiratory tract infections.

“The survey highlights instances of both good practice and poor practice within hospitals.  Using Hospital NAPS data can help improve the quality of prescribing and patient safety.

“We need to improve prescribing to keep patients safe and reduce the impact of antimicrobial resistance,” said Associate Professor Buising.

For more information or to download the 2017 Hospital National Antimicrobial Prescribing Survey refer to the Commissions website at:

For more information on Antibiotic Awareness Week 2018, refer to the Commission’s website at:




About the Commission

The Australian Commission on Safety and Quality in Health Care is an Australian Government agency that leads and coordinates national improvements in the safety and quality of health care based on the best available evidence. By working in partnership with the Australian Government, states and territories, the private sector, clinical experts, and patients and carers, the Commission aims to ensure that the health system is better informed, supported and organised to deliver safe and high-quality care.


About the AURA Surveillance System

The Antimicrobial Use and Resistance in Australia (AURA) Surveillance System enables collection and analysis of data to provide reports to inform clinical policy and practice. The AURA National Coordination Unit (NCU) at the Commission works with a range of stakeholders to inform action at the local, state and territory, and national levels to prevent and contain the spread of antimicrobial resistance. CARAlert is a core component of AURA. AURA is funded by the Commonwealth Department of Health and the Commission.


About the Hospital National Antimicrobial Prescribing Survey (Hospital NAPS)

The Hospital NAPS is conducted by the National Centre for Antimicrobial Stewardship, which is based at the Peter Doherty Institute for Infection and Immunity (a partnership between the University of Melbourne and the Royal Melbourne Hospital). The survey’s online platform was developed by the Guidance Group (Royal Melbourne Hospital). The Hospital NAPS receives funding support from the Australian Commission on Safety and Quality in Health Care as part of the Antimicrobial Use and Resistance in Australia program.