Prescribing antibiotics to outpatients in Australia

** Note: This is a press release issued by the European Conference on Clinical Microbiology and Infectious Diseases (ECCMID 2022, Lisbon, April 23-26).). Please approve the conference if you use this story**

Ban: 2301 AH UK time Wednesday 20 April

New research to be presented at this year’s European Conference on Clinical Microbiology and Infectious Diseases (ECCMID) in Lisbon, Portugal, (23-26 April) and published in the journal Clinical Infectious Diseases He found that the number of antibiotics prescribed in Australia fell by as much as 38% during the COVID-19 pandemic.

“Antibiotic resistance threatens many of the gains of modern medicine in increasing life expectancy, decreasing infant mortality and dramatically increasing preoperative risks,” says Dr. Jack Skeggs, of Monash Infectious Diseases, Monash Health, Clayton, Australia, who led the research. .

“Antimicrobial stewardship – reducing unnecessary use of antibiotics – is the first and least expensive step in preventing the development of antibiotic resistance.

“The importance of antimicrobial stewardship is widely recognized, yet outpatient programs have been more difficult to implement than in hospitals, so progress has been slower.”

Studies from around the world have shown a decrease in outpatient antibiotic prescribing during the pandemic. However, the motives for these reductions were not clear and could be due to patients avoiding or being unable to see general practitioners, strict measures such as lockdowns or less strenuous measures such as targeted mask-wearing, public education, and cultural changes in hygiene.

To find out more, Dr Jack Skeggs and colleagues at Monash Health looked at the rates of outpatient antibiotic prescriptions across Australia before and during the pandemic.

Analysis of a representative sample of 10% of outpatient antibiotic prescriptions issued from January 2014 to April 2021 showed that prior to the pandemic there was clear seasonal variation in prescribing.

Prior to 2020, antibiotic prescribing was on average 29% higher during the winter months of June, July and August, compared to the summer months of December, January and February.

This seasonal variation disappeared during the pandemic. The number of prescriptions fell sharply as national restrictions were implemented in Australia at the start of the pandemic in March 2020 and remained lower than normal during the entire period studied.

In the winter of 2020, the number of antibiotics prescribed per month decreased by 38% compared to the winter of 2018 and 2019 (1,432,000 prescriptions per month versus 2,313,000). This was even lower than typical summer: during the pandemic the average winter month was 21% lower than the average summer month before the pandemic.

Summer 2021 showed a 23% decrease in prescriptions compared to summer 2018 and 2019 (1,374,000 prescriptions per month versus 1,817,000). More details are available in Figure 1 of the summary, see link below.

Reductions were mostly in antibiotics used to treat community-acquired respiratory infections such as pneumonia and bronchitis (eg amoxicillin: winter -52%, summer -23% from pre-pandemic baseline).

Some of this decline is likely due to social distancing measures introduced to curb COVID-19 that also reduce the spread of other respiratory infections. This includes viral infections. Antibiotics may be appropriately prescribed for bacterial infections that occur after a viral infection, such as the flu. However, they are sometimes inappropriately prescribed for the viral infection itself. It is possible that both types of prescriptions may have been eroded during the pandemic.

Prescriptions of antibiotics commonly used for other indications remained stable (eg, trimethoprim, which is commonly used to treat urinary tract infections: winter -2%, summer -3%).

However, amoxicillin-clavulanate prescription followed a pattern similar to that of the antibiotics commonly used to treat community-acquired respiratory infections (winter-51%, summer-37%), although it is not recommended for this purpose under antibiotic stewardship guidelines.

The decrease in prescriptions indicates that they are usually prescribed in the community for inappropriate indications.

A decrease in antibiotic prescriptions was observed in all age groups, with the largest decrease observed in those aged 0-17 years (winter -52%, summer -24%).

Further analyzes revealed that 84% of the declines in the winter and 97% of the declines in the summer were driven by reductions in GP prescribing, despite GPs doing the same number of consultations as usual. In other words, the reductions in antibiotic prescriptions were not driven by patients’ inability or fear of seeing their GP.

In addition, reductions in antibiotic prescribing have occurred in all states and territories despite large differences in COVID-19 case numbers and duration of lockdown. For example, South Australia, which had no shutdowns during the study period, and Victoria, where stay-at-home orders were in effect for 208 days in 2020, saw similar reductions in prescribing.

Dr Skeggs says: “This is particularly promising because it suggests that the reductions were not dependent on higher case numbers or more difficult social distancing measures such as lockdowns, and so it may be possible to maintain some of the declines after the pandemic.”

Taken together, the results suggest the interpretation of the decrease in drug prescribing to be multifactorial.

Dr Skeggs says: “Existing community stewardship programs for antimicrobials, community education on personal hygiene and hand washing, cultural changes in mask wearing and social distancing, and possibly reduced prescribing for viral syndromes, may all play a role.

“However, the finding that there are significant reductions in states without significant numbers of cases or lockdowns is promising and suggests that we may be able to maintain at least some of these declines after the pandemic by encouraging these cultural shifts. itself.

“Our finding that some broad-spectrum antibiotics such as amoxicillin-clavulanate appear to be prescribed for community-acquired respiratory infections suggests that antibiotic prescribing for respiratory diseases remains an important goal for future antimicrobial stewardship programs.”

For an interview with the study author, please send an email to:

Dr. Jack Skeggs, Monash Infectious Diseases, Monash Health, Clayton, Australia

H) jack.skeggs@monashhealth.org

Alternate contact: Tony Kirby at ECCMID Media Center. Tel) +44 7834 385827 H) tony@tonykirby.com

Notes to editors:

The authors declared that there was no difference in interests.

This press release is based on abstract number 00987 from the annual meeting of the European Conference on Clinical Microbiology and Infectious Diseases (ECCMID). The materials were reviewed by the conference’s peer selection committee. The research paper was accepted on the basis of the research and published Clinical Infectious Diseases On April 11, since the offer was oral, no poster was included.


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