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.
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) due for release in January 2021.
The label has changed because taking antibiotics for longer than necessary not only does not improve outcomes, but 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 include a repeat for an antibiotic on the prescription, by default. 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 the Commonwealth has already made (see further information here: https://www.pbs.gov.au/pbs/news/2020/03/revised_pbs_listings_for_antibiotic_use_from_1_april_2020 )
See further information here: https://ajp.com.au/news/updating-the-label/