Almost 10% of residents in aged care facilities were prescribed an antimicrobial, mostly commonly cefalexin and clotrimazole, but the majority had no documented signs of infection, The 2018 Aged Care National Antimicrobial Prescribing Survey has found.
Published early ahead of World Antibiotic Awareness Week this week, the survey data was collected on 20,030 aged-care residents from 407 facilities around the country.1
On the day of the survey, almost 10% of residents in participating facilities were prescribed at least one antimicrobial. Two-thirds of those recently prescribed were for residents with no documented signs or symptoms of infection, and more than a quarter of antimicrobials had been prescribed for longer than 6 months. Over one-third of antimicrobials prescribed were topical preparations.
Skin, soft tissue or mucosal infections (18%), cystitis (16%) and pneumonia (9%) were the most common indications presumed or documented for prescribed antimicrobials.
The authors recommended that documentation of start, stop and review dates for antimicrobials was needed, given the incomplete documentation found during the survey.1
To mark Antibiotic Awareness Week for 2019, Professor Brendan Murphy, Australian Government Chief Medical Officer and Dr Mark Schipp, Australian Chief Veterinary Officer have released a joint statement on how Australians can reduce antibiotic resistance. The joint statement is published on the Australian Government’s AMR website.
As Australia is one of the highest users of antibiotics in the developed world, pharmacists and all Australians need to heed the call: It’s time to take antibiotic resistance seriously.2
The World Health Organization warns that antibiotic resistance is one of the greatest threats to human health today, but pharmacists can be part of the solution by helping preserve the effectiveness of antibiotics.2
What can pharmacists do?
Pharmacists can help patients understand when to, and when not to, use antibiotics, and how to use them. They can advise on other treatments to manage symptoms and how to prevent infections and their spread (e.g. vaccination, good hygiene and handwashing).3
Taking an antibiotic stewardship role, a pharmacist can check the prescribed indication against the therapeutic guidelines to clarify the duration of therapy required, and the timeframe for when a referral is warranted if there is an inadequate response to therapy.3
Patients should be advised to return unused and expired antibiotics to the pharmacy for safe disposal through the National Return and Disposal of Unwanted Medicines program to reduce their entrance into the environment.3
Advice when dispensing antibiotics
‘Some antibiotic pack sizes contain more dosage units than required for a course of therapy,’ Claire Antrobus MPS, PSA Manager, Practice Support, said. She advises that ‘it’s a good idea to ask patients if the prescriber has told them for how many days they need to take their antibiotics’.
Re-consider the instruction ‘Continue until all taken’ if appropriate. Be on the lookout for signs of inadequate patient response to therapy and refer promptly.5
Prescribing data has indicated that around 25% of repeat antibiotic prescriptions were dispensed more than 4 weeks after the initial dispensing. This indicates potential inappropriate antibiotic use in the community.4
Ms Antrobus reminds us of the PSA Choosing Wisely recommendation – Do not dispense a repeat prescription for an antibiotic without first clarifying clinical appropriateness.5
Pharmacists can update their knowledge by completing Australian Pharmacist CPD: Antimicrobial stewardship and pharmacy and Antimicrobial resistance – Evidence in patient care.
Other Antibiotic Awareness Week activities:
Antimicrobial resistance. Australian Government.
Antibiotic Awareness Week. NPS MedicineWise.
Antibiotic Awareness Week. Australian Commission on Safety and Quality in Health Care.
References
- Dowson L, Rajkhowa A, Buising K, et al. The 2018 Aged Care National Antimicrobial Prescribing Survey: results show room for improvement. Aust Prescr 2019. Epub 2019. Nov 14.
- Antibiotic Awareness Week. NPS MedicineWise: www.nps.org.au/antibiotic-awareness
- Department of Health: www.amr.gov.au/what-you-can-do/pharmacy
- PSA media release. New medicines advice: Prescribing cascades, polypharmacy, homeopathy. 2018. At: www.psa.org.au/new-medicines-advice-prescribing-cascades-polypharmacy-homeopathy
- Campbell C, Page A, Edwards S, et al. Choosing wisely: Antibiotics. Australian Pharmacist 2019;38(5):20–21. Choosing Wisely Recommendations – Pharmaceutical Society of Australia. At: www.choosingwisely.org.au/recommendations/pharmaceutical-society-of-australia
