Antimicrobial stewardship in primary care

AURA

Primary care is one of a number of focus areas for the Commission to improve the safe and appropriate use of antimicrobials, reduce patient harm and decrease the risk of antimicrobial resistance in Australia in the community.

 

Why is primary care a focus area for improved prescribing?

AURA 2019 Third Australian report on antimicrobial use and resistance in human health reports 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 Repatriation Pharmaceutical Benefits scheme (RPBS).

AURA 2019 also reports that, although there has been a decline in antimicrobial use in the community since 2015, Australia remains in the top quarter of countries for antimicrobial use, as measured by defined daily doses (DDDs) per 1,000 inhabitants, compared with 30 European countries and Canada.  It is important to capitalise on the decline in antimicrobial use to further improve the safety of patients and reduce the risk of antimicrobial resistance. 

In 2017, a large percentage of patients from participating NPS MedicineWise MedicineInsight practices were prescribed antibiotics for which there is no evidence of benefit, including for:

  • Influenza (52.2% of patients with this condition recorded) 
  • Acute bronchitis (92.4% of patients with this condition recorded).

In addition, there are high levels of inappropriate prescribing of antimicrobials in aged care homes, and concerning rates of some antimicrobial-resistant organisms in aged care home residents. In the community, there is also increasing non-susceptibility to fluoroquinolones in Escherichia coli, increasing vancomycin non-susceptibility in Enterococcus faecium and community-onset methicillin-resistant Staphylococcus aureus infections.

Useful resources include: