Aus antimicrobial use decreasing but not enough: report
Friday, 27 August, 2021
The (AURA 2021), released today by the , highlights the ongoing public health and safety threat posed by antimicrobial resistance.
Claimed to be the most comprehensive report produced on Australian antimicrobial use and resistance trends to date, it found that while antimicrobial use in the community is decreasing, overprescribing and inappropriate prescribing continue to be problematic. Antimicrobial resistance to commonly prescribed antibiotics remains an ongoing threat.
While AURA 2021 found that overall use of antibiotics in the community has continued to decline since 2015, Australia continues to prescribe antimicrobials at much higher rates than most European countries and Canada. In 2019, more than 40% of the Australian population (just over 10 million people) had at least one antimicrobial dispensed in the community, and more than 26.6 million prescriptions were dispensed for antimicrobials. The 2020 data showed a decline of more than 30% in dispensing of antimicrobials under the Pharmaceutical Benefits Scheme during COVID-19.
鈥淭he gradual decline in prescribing since 2015 will need to be sustained in order to slow the spread of resistance,鈥 said Professor John Turnidge AO, the Commission鈥檚 AURA Senior Medical Advisor.
鈥淚t is extremely concerning that AURA 2021 shows that many patients continue to be prescribed antimicrobials for conditions for which there is no evidence of benefit 鈥 including more than 80% of patients with acute bronchitis and acute sinusitis,鈥 he said.
AURA 2021 shows that antimicrobial use has increased in hospitals, and the rate of overall appropriateness of prescribing has been static for some time. These data will be more closely reviewed to identify potential causes and enhance strategies to respond.
鈥淭here has also been a static rate of inappropriate antimicrobial prescribing in hospitals, particularly for chronic obstructive airways disease (COPD) and other respiratory conditions,鈥 Prof Turnidge said. 鈥淎URA 2021 highlights the need for continued interventions to address the issue of inappropriate prescribing, and antimicrobial stewardship programs within hospitals are central to this effort.鈥
In addition, there is a long-term high level of inappropriate antimicrobial use and multidrug resistance in aged-care homes, which highlights the importance of effective infection control and antimicrobial stewardship in that setting.
鈥淭hese are again areas of opportunity for improvements in patient care through national and local improvement activities in relation to COPD and other respiratory illnesses, and the antimicrobials amoxicillin鈥揷lavulanic acid and cefalexin,鈥 Prof Turnidge said.
The report warns that antimicrobial resistance poses an ongoing risk to patient safety, with common pathogens such as E. coli, which commonly causes urinary tract infections and may cause infections in the bloodstream, becoming increasingly resistant to major drug classes, and some organisms resistant to last-resort treatments.
Just over 40% of enterococci tested in 2019 were resistant to the antimicrobial vancomycin 鈥 a small decrease compared with 2017, but still higher than seen in more than 30 European countries. AURA 2021 also found that community-associated methicillin-resistant Staphylococcus aureus (MRSA) continues to be the most common type of MRSA infection in remote regions generally, and in far northern Australia in particular.
鈥淎URA 2021 clearly identifies focus areas that need increased and ongoing attention 鈥 including reducing inappropriate prescribing of antimicrobials, particularly for skin and asymptomatic urinary tract infections in aged care; and improving the appropriateness of antimicrobial prescribing for COPD and other respiratory infections,鈥 Prof Turnidge said.
鈥淭he volume of data in the AURA Surveillance System allows us to identify and track national trends in antimicrobial use and antimicrobial resistance, and monitor the effect of changes in policy and clinical practice, to a level that has not previously been possible.
鈥淭his latest report is one of the most comprehensive of its type in the world. It will help give clinicians and health policymakers across Australia the data and information they need to develop targeted approaches to prevent and contain resistance and improve the safety of care provided to patients in hospitals and the community, and aged-care home residents.鈥
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