24 January 2018

Antibiotics campaigns hit the mark

Drugs General Practice

Campaigns to combat antibiotic prescribing in primary care have been heralded a success, with research showing 14% fewer antibiotics were dispensed for upper respiratory tract infections each month after major efforts.

While some strategies, such as the letters sent to GPs comparing their prescribing habits with that of their peers, were criticised by some in the sector, study author Dr Jonathan Dartnell said the data vindicated these interventions.

“Obviously there is a way to go beyond this,” the clinical improvement services manager at NPS MedicineWise told The Medical Republic.

“But when you look at the prescribing rates for GPs over time compared with non-GP specialists, there is a fairly clear picture that there’s a reduced rate of antibiotic prescribing.”

The combination of peer-comparison feedback, national education programs and consumer advertising, all contributed to 127,000 fewer than expected antibiotics being dispensed on average each month.

While the dispensing rates maintained an upward trend among non-GPs, they dropped substantially among GPs after the launch of nationwide campaigns.

“It shows that GPs have been prepared to change the way they practise if given evidence and reasons to change that practise,” Dr Dartnell said.

These figures come from an analysis of PBS and MBS data from 2005 to 2015 by NPS MedicineWise researchers, and a forecast of prescribing numbers.

The focus on antibiotic prescribing within primary care has faced backlash by some who argued that the majority of antibiotic use responsible for the rise in resistance occurs within agriculture.

But greater awareness of the personal and public harms of unnecessary antibiotic prescribing galvanised efforts, and by 2012, one third of Australian GPs took part in education activities related to this issue.

“In 2014, 46% of the Australian population was prescribed antibiotics [at least once] and at least half of these prescriptions may have been unnecessarily issued,” Dr Dartnell and his colleagues wrote, highlighting upper respiratory tract infections as a major area of overprescribing.

“Recently, 47% of patients diagnosed with an acute URTI were prescribed an antibiotic despite guidelines indicating an acceptable range of 0% to 20%.”

While 2009 kicked off one major campaign to curb antimicrobial resistance, it was the five years between 2012 and 2017 when a more intense approach was adopted. That included clinical audits, comparative feedback on prescribing, face-to-face education, webinars, mass audience advertising, pharmacy education and the distribution of resources.

Within six months of the 2012 launch, the rates of antibiotic dispensing were almost 20% lower than forecasted.

As well as curbing the rise of antibiotic-resistant bacteria and extending the lifespan of our current antibiotics, the study authors said that lower dispensing rates were linked to lower rates of re-consultations, hence a potentially reduced burden on GPs and the health system in general.

J Int Med Res; online January