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Reducing antibiotic prescribing in Australian general practice: time for a national strategy

Christopher B Del Mar, Anna Mae Scott, Paul P Glasziou, Tammy Hoffmann, Mieke L van Driel, Elaine Beller, Susan M Phillips and Jonathan Dartnell
Med J Aust 2017; 207 (9): 401-406. || doi: 10.5694/mja17.00574

Summary

 

  • In Australia, the antibiotic resistance crisis may be partly alleviated by reducing antibiotic use in general practice, which has relatively high prescribing rates — antibiotics are mostly prescribed for acute respiratory infections, for which they provide only minor benefits.
  • Current surveillance is inadequate for monitoring community antibiotic resistance rates, prescribing rates by indication, and serious complications of acute respiratory infections (which antibiotic use earlier in the infection may have averted), making target setting difficult.
  • Categories of interventions that may support general practitioners to reduce prescribing antibiotics are: regulatory (eg, changing the default to “no repeats” in electronic prescribing, changing the packaging of antibiotics to facilitate tailored amounts of antibiotics for the right indication and restricting access to prescribing selected antibiotics to conserve them), externally administered (eg, academic detailing and audit and feedback on total antibiotic use for individual GPs), interventions that GPs can individually implement (eg, delayed prescribing, shared decision making, public declarations in the practice about conserving antibiotics, and self-administered audit), supporting GPs’ access to near-patient diagnostic testing, and public awareness campaigns.
  • Many unanswered clinical research questions remain, including research into optimal implementation methods.
  • Reducing antibiotic use in Australian general practice will require a range of approaches (with various intervention categories), a sustained effort over many years and a commitment of appropriate resources and support.

 

  • Christopher B Del Mar1
  • Anna Mae Scott1
  • Paul P Glasziou1
  • Tammy Hoffmann1
  • Mieke L van Driel2
  • Elaine Beller1
  • Susan M Phillips3
  • Jonathan Dartnell4

  • 1 Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, QLD
  • 2 University of Queensland, Brisbane, QLD
  • 3 Therapeutic Guidelines, Melbourne, VIC
  • 4 NPS MedicineWise, Sydney, NSW

Correspondence: CDelMar@bond.edu.au

Acknowledgements: 

We received funds from the National Health and Medical Research Council for the Centre for Research Excellence in Minimising Antibiotics in Acute Respiratory Infections in Primary Care.

Competing interests:

We have been commissioned by the Australian Commission for Safety and Quality and Health Care and Bupa to provide expertise and to design patient decision aids.

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