Australian antibiotic prescriptions drop 38% during pandemic

There were 38% fewer antibiotics dispensed in winter 2020 than over the same periods of 2018 and 2019, new research has shown.
 
The findings support a trend first identified in August 2021, which showed that antibiotics dispensed via the PBS had dropped by 40% between March and April 2020, with general practice leading the charge.
 
The research, presented at the European Congress of Clinical Microbiology and Infectious Diseases in Portugal, analysed a representative sample of 10% of outpatient antibiotic prescriptions issued from January 2014 to April 2021.
 
Despite GPs carrying out a consistent number of consultations throughout the entire seven year period, 84% of winter and 97% of summer decreases noted since the pandemic began were still driven by reductions in GP prescribing.
 
Additionally, the drop in prescriptions was seen across all states, including South Australia where there were no lockdowns during the study period, suggesting social distancing measures were not the sole cause of the decrease and that lower prescribing levels will continue.
 
‘Antibiotic resistance threatens many of the gains of modern medicine,’ lead researcher Dr Jack Skeggs said.
 
‘Antimicrobial stewardship – reducing unnecessary use of antibiotics – is the first and least costly step in preventing the development of antibiotic resistance.’
 
According to Dr Skeggs, reducing the use of antibiotics has proved more difficult in outpatient programs than hospitals, but there is now hope lower levels of prescribing in this setting will become the new norm due to a number of factors.
 
‘Existing community antimicrobial stewardship programs, community education related to personal hygiene and handwashing, culture shifts in mask wearing and social distancing and, possibly, reduced prescribing for viral syndromes may all play a role,’ he said.
 
‘The finding that significant reductions existed in states without high case numbers or lockdowns is promising and suggests that we may be able to maintain at least some of these decreases after the pandemic by encouraging these same culture shifts.’
 
The drop in prescriptions was seen across all jurisdictions, with Victoria, where stay-at-home restrictions were in place for 208 days in 2020, experiencing comparable reductions in prescribing to states that did not have lockdowns or significant case numbers.
 
And despite there being ‘clear seasonal variation’ in prescribing, reductions remained consistently lower throughout the study window.
 
Before 2020, antibiotic prescribing was 29% higher on average during the winter months than in the summer months, with this seasonal variation disappearing during the pandemic.
 
Reductions were predominantly seen in antibiotics used to treat community-acquired respiratory infections such as pneumonia and bronchitis, eg amoxicillin.
 
During the pandemic average winter month, prescribing was 21% lower than pre-pandemic summer month averages. Summer 2021 also showed a 23% reduction in prescriptions compared to the summers of 2018 and 2019 (1,374,000 prescriptions per month versus 1,817,000).
 
Decreases in antibiotic prescription were observed across all age groups, with the largest reductions seen in those aged 0–17 years (down 52% in and 24% in summer).
 
The authors plan to continue monitoring surveillance data to raise awareness of trends in antimicrobial resistance in the hospital and community settings.
 
‘Our finding that certain broad-spectrum antibiotics like amoxicillin-clavulanate appear to be being prescribed for community-acquired respiratory infections suggests that antibiotic prescribing for respiratory illness remains a valuable target for future antimicrobial stewardship programs,’ Dr Skeggs said.
 
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antibiotics antimicrobial resistance pandemic prescribing