Australian general practitioners are prescribing antibiotics for acute respiratory infections (ARIs) at rates that are 4 to 9 times higher than recommended by national guidelines, according to the authors of research published in the Medical Journal of Australia.
Led by Christopher Del Mar, Professor of Public Health at Bond University, the researchers compared general practice activity for April 2010 to March 2015 (based on data from the Bettering the Evaluation and Care of Health (BEACH) study) with the estimated rates of prescribing recommended by Therapeutic Guidelines.
They found that an estimated mean of 5.97 million ARI cases per year were managed in Australian general practice with at least one antibiotic, equivalent to 230 cases per full-time equivalent GP/year.
Antibiotics are not recommended by the guidelines for acute bronchitis/bronchiolitis, but GPs are prescribing them in 85% of cases. Similarly, they are not recommended for influenza, but are being prescribed in 11% of cases.
Antibiotics are always recommended for community-acquired pneumonia (current prescribing rate, 72%) and pertussis (71%), as well as for 0.5–8% of cases of acute rhinosinusitis (current prescribing rate, 41%), 20–31% of cases of acute otitis media (89%), and 19–40% cases of acute pharyngitis or tonsillitis (94%).
“Had GPs adhered to the guidelines, they would have prescribed antibiotics for 0.65–1.36 million ARIs per year nationally, or at 11–23% of the current prescribing rate,” the authors wrote.
“Antibiotics were prescribed more frequently than recommended for acute rhinosinusitis, acute bronchitis/bronchiolitis, acute otitis media, and acute pharyngitis/tonsillitis.”
“Diagnostic uncertainty — concern by the treating doctor that a serious infection or complications might be missed — is one potential explanation for this finding,” the authors wrote.
They said that their findings were the first to quantify the overprescribing of antibiotics in Australia.
Antimicrobial drug resistance is a global problem, and reducing antibiotic use is the most important clinical response, according to national and international guidelines on antimicrobial stewardship.
"The potential for reducing rates of antibiotic prescription and to thereby reduce rates of antibiotic-related harms, particularly bacterial resistance, is … substantial,” Del Mar and his colleagues concluded. “Our data provide the basis for setting absolute targets for reducing antibiotic prescribing in Australian general practice.”
To view the article on MJA online first, click here.