Antimicrobial stewardship in primary care

AURA

The primary care sector has an important role to play in improving the safe and appropriate use of antimicrobials, and reducing patient harm and the risk of antimicrobial resistance in Australia.

Why is primary care a focus area for improved prescribing?

AURA 2021, the Fourth Australian report on antimicrobial use and resistance in human health reported on data from 2019, that overall, the use of antimicrobials is decreasing in the community (including general practice, specialist outpatient clinics, dental clinics and aged care homes). 

While this is a positive trend, antimicrobials continue to be overprescribed in the community, compared with national guideline recommendations. 81.5% of patients with acute bronchitis and 80.1% of patients with acute sinusitis attending NPS MedicineWise MedicineInsight participating practices continue to be prescribed antimicrobials for conditions for which there is no evidence of benefit.

Since 2006, there have been increases in the community for some important resistances in Australia, such as methicillin resistance in Staphylococcus aureus (MRSA). When people go into hospital with a resistant infection they caught in the community, it makes their care more complex, which is why reducing resistance in the community is also important. 

In addition AURA 2021 reported on continuing high levels of inappropriate prescribing of antimicrobials in aged care homes, and concerning rates of some antimicrobial-resistant organisms in aged care home residents.

A number of resources are provided on this page to support improved prescribing in the community.  

Useful resources

Commission:

2021
Publication, report or update

External:

Labelling change for antibiotics

The cautionary advisory label used by pharmacists for antibiotics has now changed to ‘Take for [the number of] days as advised by your prescriber’. The previous wording was  – ‘until all used/taken’. This change will be reflected in the Australian Pharmaceutical Formulary and Handbook (APF 25).

The label has changed because taking antibiotics for longer than necessary does not improve outcomes and increases the risk of acquiring resistant bacterial strains. The required duration of treatment with an antibiotic may need a smaller quantity of antibiotic than the pack that is supplied to the patient; therefore reminding patients that they may not need to take the whole pack becomes an even more important message.

It is also not generally appropriate for prescribers to routinely include a repeat for an antibiotic on the prescription. Pharmacists should not dispense a repeat prescription for an antibiotic without first clarifying clinical appropriateness.

The label change will reinforce the PBS changes to repeats for antibiotics that have already made (see: https://www.pbs.gov.au/pbs/news/2020/03/revised_pbs_listings_for_antibiotic_use_from_1_april_2020)

Further information is available at: https://ajp.com.au/news/updating-the-label/