Drop in antibiotic use shows potential to address over-prescribing

Morgan Liotta

31/08/2021 3:28:46 PM

Can a COVID-related dip in prescribing play a role in addressing antimicrobial resistance in a post-pandemic era?

Blister pack of pills
Around 70% of Australia’s antibiotic prescriptions are dispensed by GPs.

The COVID-19 pandemic has overshadowed many areas of healthcare since it began. And according to the latest report on antimicrobial use and resistance in Australia, antibiotic prescribing is one of those areas.
Antimicrobials dispensed through the Pharmaceutical Benefits Scheme (PBS) in 2020 show a 40% drop between March and April.
Usage has remained at this lower level since, despite stable rates of GP consultations with the expansion of COVID-related telehealth services. The change was largely the result of a drop in antimicrobial dispensing for seasonal respiratory viral infections, as a result of COVID-19 public health measures and restrictions.
Drawing on national PBS data, new research from the Murdoch Children’s Research Institute (MCRI) and UNSW Sydney examines the decline in antibiotic prescribing in the COVID era.
‘Despite the obvious and unfolding negative effects of COVID-19, the pandemic and the public health responses have given us a series of unprecedented natural experiments,’ MCRI study lead and infectious diseases Professor David Burgner told newsGP.
‘The main reason for the fall-off in antibiotic prescriptions seems to be the concomitant reduction in respiratory viral infections.
‘The biggest reduction in prescription rates were for antibiotics predominantly used for respiratory infections, such as amoxycillin and clarithromycin, both at a 50% reduction, and roxithromycin at 70%.’
There were no reductions in prescribing of antibiotics generally used to treat non-respiratory infections.
The drop in antibiotic dispensing continued into winter, in contrast to the seasonal nature of antibiotic prescribing before the pandemic.
‘This implies that antibiotics were being used widely for viral respiratory infections in primary care,’ Professor Burgner said.
‘We have not seen a concomitant rise in hospitalisations with non-COVID respiratory infections or deaths, as far as I am aware, following the first lockdown, implying that marked reductions in inappropriate antibiotic prescribing should be safe.
‘The lockdowns have meant that the incidence of other non-COVID-19 infections plummeted due to increased hygiene, masking and reduced social mobility and interaction.’
Despite the COVID-related decrease in antibiotic prescribing, tackling antimicrobial resistance remains a significant challenge.
Professor Burgner said the MCRI study helps to inform progress for ‘post-pandemic antimicrobial stewardship’ and the potential to reduce over-prescribing.
‘There is considerable scope to reduce primary care prescriptions for antibiotics, especially for viral respiratory infections,’ he said.
‘Australia is one of the most profligate prescribers of antibiotics among high-income countries. During the five years prior to the pandemic, almost 20 million people in Australia were prescribed about 125.5 million courses of antibiotics. [That is] roughly one course of antibiotics for every person, each year, not including hospital prescriptions.’
Of these antibiotics, 71% were prescribed by GPs. ‘Unwarranted’ prescribing for viral upper- and lower-respiratory tract infections has been estimated to account for 40% of antibiotics prescribed by Australian GPs.
Professor Burgner said these figures further underline primary care’s role in antibiotic stewardship.
‘GPs should be playing a major leadership role in antibiotic stewardship in the community, where most antibiotic prescribing occurs,’ he said.
‘It is important to identify the key drivers for the high levels of prescribing and opportunities for education and prevention.’
Although the research is ‘potentially of considerable significance’ in addressing antibiotic resistance, Professor Burgner warns there is still work to be done.
‘Most antibiotic prescribing in Australia and elsewhere happens outside hospitals. While the focus of [antimicrobial stewardship] has been in healthcare settings, there is clearly considerable potential to make major and safe reductions in antibiotic use in the community as well,’ he said.
‘Inappropriate antibiotic use is the major driver of resistance, and antibiotic resistance hasn’t gone away during the pandemic.
‘We can’t afford to take our eye off this major public health issue, despite the other immediate and important competitors for our attention.’
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SD   1/09/2021 12:51:19 PM

I agree that decline in antibiotic prescribing is likely due to decrease in secondary bacterial infections after flu. Due to increased hygiene and social distancing, flu and atypical pneumonias has been less than usual.
Other reason is that considerable number of GP practices are not seeing patients F2F with URTI symptoms thus not diagnosing and prescribing for lung conditions requiring antibiotics.