Volume 202 - Issue 11
Knowing when to stop antibiotic therapy
Authors: Angus J Thompson, Ivan Bindoff and Andrew C Stafford
Med J Aust 2015; 202 (11): 570. || doi: 10.5694/mja15.00249
Published online: 15 June 2015
Published online: 15 June 2015
Improving use of antimicrobials in Australia requires change in doctors’ practice and PBS arrangements
To the Editor: The recent article by Gilbert usefully drew attention to the the harms that can arise from unnecessarily long courses of antibiotics.1 It was of particular interest that she highlighted the misconception that resistance will emerge if a course of treatment is not completed.
Australian health professionals commonly advise patients verbally to complete antibiotic courses, and professional guidance for pharmacists specifically recommends annotating dispensing labels with the words “until all used” or “until all taken”.2 This recommendation appears to be widely implemented based on our analysis of de-identified dispensing records collected as part of the PROMISe III trial.3
This dataset contains over 11 000 dispensings for the two most widely prescribed antibiotics in Australia, cephalexin and amoxycillin.4 Dispensing directions included a reference to completing the course in 87.9% and 91.7% of prescriptions for these two drugs, respectively.
The impact of advice to complete antibiotic courses is likely to be magnified in Australia by two further system factors, namely the poor alignment of pack sizes with clinically appropriate course durations and the widespread practice of prescribing antibiotics with repeat prescriptions.5
A significant change in both professional practice and the arrangements under the Pharmaceutical Benefits Scheme will therefore be necessary if we are to avoid perpetuating current habits, which may be contrary to efforts now being made to improve antimicrobial stewardship.
Competing interests
No relevant disclosures.
References
- Gilbert GL. Knowing when to stop antibiotic therapy. Med J Aust 2015; 202: 121-122. _Ref420496124
- Sansom LN, editor. Australian pharmaceutical formulary and handbook. 22nd ed. Canberra: Pharmaceutical Society of Australia, 2012. _Ref420496202
- Williams M, Peterson GM, Tenni PC, et al. Drug-related problems detected in Australian community pharmacies: the PROMISe Trial. Ann Pharmacother 2011; 45: 1067-1076. _Ref420496293
- PBS Information Management Section, Pharmaceutical Policy Branch, Australian Government Department of Health. Expenditure and prescriptions twelve months to 30 June 2014. http://www.pbs.gov.au/statistics/2013-2014-files/expenditure-and-prescriptions-12-months-to-30-june-2014.pdf (accessed Feb 2015).
- Newby DA, Fryer JL, Henry DA. Effect of computerised prescribing on use of antibiotics. Med J Aust 2003; 177: 210-213. _Ref420496434