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Critical antimicrobial resistances up by 25%
Findings from the latest CDC report further underline the need for improved prescribing practices and public awareness of the ‘silent pandemic of our age’.
Australian GPs prescribed more than 23 million antimicrobial prescriptions in 2024, demonstrating their central stewardship role.
Australia is witnessing a growth in both antibiotic prescriptions and critical antimicrobial resistances, the latest report collating available national data and trends on antibiotic use reveals.
Recognised as a key part of Australia’s long-term response to antimicrobial resistance, the sixth antimicrobial use and resistance (AURA) report from the Australian Centre for Disease Control (CDC) includes data from general practices, hospitals and aged care facilities.
It warns that antimicrobial resistance is ‘threatening the foundation’ of Australia’s healthcare system, with critical antimicrobial resistances presenting a serious threat to the effectiveness of last-line antimicrobial agents, often leading to prolonged infection and illness, having increased by 25.2% between 2023 and 2024.
The increase in critical antimicrobial resistances also places greater pressure on the health system, with more complex care, extended hospital stays, and increased resource requirements, with the report outlining this is why it remains ‘critical to maintain effective antimicrobials’ for community use.
Bond University Professor of General Practice Mark Morgan is Chair of the RACGP Expert Committee – Quality Care and represents the college on the national Antimicrobial Stewardship Advisory Committee. He is also a chief investigator in Medical Research Future Fund research into the implementation of antimicrobial stewardship in general practice and aged care settings.
He told newsGP antimicrobial resistance is ‘the silent pandemic of our age’.
‘Superbugs used to be rare and related to prolonged hospital stays with multiple antibiotics, but increasingly people are coming into hospital with these hard-to-treat infections,’ he said.
‘It is estimated that in 2021 there were 4.71 million deaths associated with antibiotic resistance globally.’
With the majority (87%) of antimicrobials in the community prescribed under the Pharmaceutical Benefits Scheme (PBS) by GPs, the AURA report reveals 23.2 million antimicrobial prescriptions were supplied to around 37% of Australians under the PBS and Repatriation Pharmaceutical Benefits Scheme in 2024.
These figures mark a 4.8% increase from 2023, but are still 13% lower than 2019, and 20.8% lower than in 2015 – with Professor Morgan saying that despite numbers climbing there are ‘some positive trends’.
In 2024, the most frequently dispensed antimicrobials in the community were amoxicillin (22.0%), cefalexin (21.7%), amoxicillin–clavulanic acid (14.6%) and doxycycline (11.5%).
Professor Morgan, who is also Chair of the RACGP’s First do no harm: a guide to choosing wisely in general practice, says the AURA report findings further highlight the central role GPs have in guiding antimicrobial stewardship.
‘Australia continues to use antimicrobials in much larger amounts than some other equivalent countries,’ he said.
‘We should ask ourselves why, and what can be done about it? It is not easy when there are expectations to manage and a culture of treating infections with antimicrobials.’
He says GPs can use the college’s resource to support conversations with patients about low-value or harmful care and alternatives. Meanwhile, the Therapeutic Guidelines provides clinical, evidence-based advice for preventing and treating infections.
Other AURA findings reveal opportunities to improve antimicrobial prescribing in hospitals, particularly for those used as first- or second-option treatments. Less than half (45%) of antibiotics given after surgeries were considered appropriate, while 88.1% of ‘last-line’ antibiotics were prescribed appropriately in hospitals. Antibiotics used as first- or second-line options were prescribed correctly around 72% of the time.
Community dispensing of antibiotics is climbing, with 14.4% more prescribed to older Australians in residential aged care in 2024 compared to the previous year. Additionally, 34.7% of antibiotics prescribed to aged care residents were used for more than six months.
Multidrug-resistant bacteria were present in 12.2% of bloodstream infections in children.
A CDC spokesperson says the findings show ‘the need for us to focus our attention a lot more strongly in targeted areas’.
‘There appears to be less caution when prescribing antibiotics that are considered to have a lower risk of promoting resistance, resulting in their more frequent use even in situations where there is no clear benefit,’ they said.
‘Identifying these pressure points – as this analysis has done – is critical if we are to safeguard treatment options for the future.’
With the report demonstrating the use of surveillance data in safeguarding public health, it calls for a ‘coordinated effort across healthcare settings’ to strengthen antimicrobial stewardship practices, improve prescribing practices and infection prevention measures, and increase public awareness of antimicrobial resistance.
Supporting GPs is ‘key to driving sustainable change in prescribing behaviour in the community’, it says.
To strengthen these practices in primary care settings, the report calls for a focus on:
- access to and increased adherence to antimicrobial guidelines
- improved assessment of treatment duration, infection confirmation, and documentation
- targeted antimicrobial stewardship initiatives such as prescriber training, prescribing audits and decision support tools
- improved appropriateness and reduction in unnecessary use.
It also states as well as the volume, appropriateness of prescribing is key to driving necessary improvements.
Despite the report’s robust data, the authors note surveillance gaps that require addressing to improve ‘understanding and ability to respond to antimicrobial resistance threats’. These include private prescriptions under the PBS, prescriptions dispensed by Aboriginal and Torres Strait Islander health services, or over-the-counter medicines supplied without a prescription.
As well, the rise in
community pharmacy prescribing programs presents an emerging gap, with the report cautioning that ‘the absence of systems to record and monitor these prescriptions remains a significant blind spot in Australia’s antimicrobial use surveillance.’
The rise of antimicrobial resistance impacting health outcomes and placing pressure on the health system further highlights the need for continued national surveillance, says the CDC spokesperson.
‘National surveillance matters,’ they said.
‘By detecting risks through concrete data, Australia can act before antimicrobial resistance becomes pervasive.’
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antibiotic prescribing antibiotics antimicrobial resistance antimicrobial stewardship critical antimicrobial resistances PBS
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