A five-year trend report on antimicrobial medicines use in Australia has revealed a sustained pattern of high use in some of the most disadvantaged areas of major cities, with outer areas of Sydney, Brisbane and Melbourne identified as having the highest rates of antimicrobial dispensing year after year.
The Antimicrobial Medicines Dispensing from 2013-14 to 2017-18 report, released today by the Australian Commission on Safety and Quality in Health Care (the Commission), also shows encouraging results, with a downward trend in national antimicrobial dispensing rates, which fell 13.3% over five years.
While there has been a modest decline in antimicrobial use, the report indicates potential overuse in some geographical areas. This is the first analysis to probe antimicrobial prescribing at every level over five years - national, state and territory, Primary Health Network (PHN) and local area.i
The report builds on the findings of the Third Australian Atlas of Healthcare Variation, which examined antimicrobial medicines dispensing from 2013-14 to 2016-17. It also complements the data on antimicrobial prescribing and use provided in the AURA 2019: Third Australian report on antimicrobial use and resistance in human health.
Professor John Turnidge AO, the Commission's Senior Medical Advisor, said being able to compare local level data will enable the healthcare sector to take a more active role in tackling antimicrobial use and the threat of antimicrobial resistance in the community through more targeted strategies.
"It is significant that we are witnessing the first evidence of a consistent decline in antimicrobial consumption in Australia since the last decline in 2003ii. 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," he said.
Australia's antimicrobial prescription rate remains high by international standards, with 22.7 defined daily doses per 1000 people in 2017-18, more than double the equivalent figure in The Netherlands and Sweden, 8.9 and 10.8, respectively.iii
"Focusing on reduced prescribing in areas where there is high use will help to drive down our national antimicrobials consumption," Professor Turnidge said. "This data will be tremendously helpful for clinicians, who can use it to identify potentially inappropriate antibiotics use in their local area, which may lead to better care for patients and declines in antimicrobial resistance.
"Primary Health Networks and Local Health Districts will also be able to implement targeted interventions in areas with antimicrobial dispensing rates consistently in the top 10% each year over the five years, including local areas in outer Sydney, Brisbane and Melbourne."
In 2017-18, 28.2 million prescriptions for antimicrobialsiv were dispensed in the community, compared with 30.3 million prescriptions in 2013-14, the report found. Progress was also seen with the decrease in volume of antimicrobial medicines supplied on any given day in the Australian communityv, down by 4% over the most recent three years.
High use associated with disadvantage in major cities
The analysis identified some areas where antimicrobials continue to be excessively prescribed. There are 22 areas that have had consistently highvi rates of antimicrobials dispensing over the five-year period, with 20 of these located in major cities (91%).
Areas with consistently high antimicrobial dispensing rates include: 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 (16 areas or 73%) are in the lowest quintile of socioeconomic status (SES).
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.
Professor Turnidge added: "The findings show a downward shift in prescribing in most areas, which is encouraging, but not at the pace needed in some. 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.
Examining antimicrobial use can help GPs improve patient care
Dr Liz Marles, a Sydney-based general practitioner and Past President of the Royal Australian College of General Practitioners, said the latest data would allow general practitioners to examine patterns of antibiotic use in their local community, leading to improved patient care.
"It is really pleasing to see a persistent reduction in antibiotic use across all geographical areas, indicating that both general practitioners and the public have taken on-board the educational messages about appropriate antimicrobial use," she said.
"There is still a significant way to go if we compare ourselves to similar OECD countries. All clinicians, including GPs, need to ensure a sustained effort to continue to improve patterns of prescribing.
"Some areas are doing particularly well - such as the low rates seen in Perth North and Perth South Primary Healthcare Networks. It would be good to investigate why these rates are so different from those of PHNs in Sydney, Melbourne and Brisbane.
Dr Marles added: "Overuse and misuse of antibiotics poses an ongoing risk to patient safety, and we know that improving patient understanding of the potential harms can lead to a decline in prescribing and use. Shared decision making between doctors and patients can also help address concerns around antimicrobial resistance.
"In this COVID era, we are seeing the impact of not having an effective treatment for an infectious disease. Antimicrobial resistance is critical for the whole community to address. Every GP can contribute by using guidelines to inform decision making, and auditing to identify where we can improve."
