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25 Nov 2014

Thousands of hospital patients are being prescribed antibiotics that are too broad, do not treat the problem, are of the wrong dose or are not what they need, adding weight to calls for improvements in prescribing practices to combat the rise of antibiotic resistance.

In a result that calls into question how and why many antimicrobials are used, an Australian Commission on Safety and Quality in Health Care (ACSQHC) study has found almost a third of antibiotics used in Australian hospitals are being prescribed inappropriately, either because they were too broad, were being used for too long or too short a period, were of incorrect dose or were too narrow.

The findings came as a National Prescribing Service survey showed many GPs were prescribing antibiotics for health problems where they would be no use because of a desire to keep their patients happy.

The NPS survey found 57 per cent of doctors would prescribe an antibiotic for patients with a viral infection of the upper respiratory tract, blaming limited consultation time, a desire to preserve their relationship with their patients and concern they might be sued if they missed a diagnosis.

Already, Australia is one of the world’s heaviest users of antibiotics, with concerns it is contributing to the worldwide rise of antibiotics resistant infections.

Each year, an average of almost one antibiotic prescription is issued for every man, woman and child in Australians, and there are 24 daily doses prescribed for every 1000 people – well above the developed country average of 18 per 1000.

Commonwealth Chief Medical Officer Professor Chris Baggoley said antimicrobial resistance was “one of the major threats to human health”.

There is a real concern that, without new antibiotics in the development pipeline, some infections will be difficult or impossible to treat,” Professor Baggoley said.

The threat has increased the focus on how antibiotics are being used in the nation’s hospitals, where the evidence is mixed.

Based on data from 151 public and private hospitals, the ACSQHC report National Antimicrobial Prescribing Practice: Results of the 2013 National Antimicrobial Prescribing Survey found antibiotics were being used in a clinically appropriate manner in 70.8 per cent of cases, and compliance with best practice was higher among narrow-spectrum agents such as flucloxacillin, benzylpenicillin and vancomycin.

But the quality of prescribing fell away when it came to broader spectrum antibiotics, particularly cephalexin, ceftriaxone and cephazolin.

Based on data from 12,800 prescriptions, the study found that the prescription of cephalexin, often used to treat pneumonia and urinary tract infections, was inappropriate in almost 40 per cent of cases, most commonly because it was too broad or was of incorrect does or duration.

Worryingly, the use of the most commonly prescribed antibiotics, ceftriaxone and cephazolin (each accounting for almost 10 per cent of all antibiotics prescribed) was considered inappropriate in one out of every three instances.

The study found that antibiotics were most commonly prescribed for surgical prophylaxis (11.5 per cent of indications) and, disturbingly, were being used inappropriately 42 per cent of the time. Even worse, it was prescribed for more than 24 hours in 41 per cent of cases – far in excess of the 5 per cent that is considered best practice.

The level of appropriateness was even worse when it came to prescribing antibiotics for patients with chronic obstructive pulmonary disease – antibiotic use was considered acceptable in just 52 per cent of instances.

Adrian Rollins 

Published: 25 Nov 2014