Aussie GPs greatly overprescribing antibiotics for ARIs

Antibiotics for throat and lung infections are being prescribed by Australian general practitioners at significantly higher levels rates than recommended by national guidelines.

Research published in the Medical Journal of Australia found GPs are prescribing antibiotics for acute respiratory infections (ARIs) at rates four to nine times higher than recommended.

Led by Christopher Del Mar, Professor of Public Health at Bond University, the researchers compared general practice activity from April 2010 to March 2015 — based on data from the Bettering the Evaluation and Care of Health (BEACH) study — with the estimated rates of prescribing recommended by Therapeutic Guidelines.

Antibiotics are not recommended by the guidelines for acute bronchitis/bronchiolitis, but GPs are prescribing them in 85% of cases. Similarly, they are not recommended for influenza but are being prescribed in 11% of cases.

Antimicrobial drug resistance is a global problem, and reducing antibiotic use is the most important clinical response, according to national and international guidelines on antimicrobial stewardship.

“The potential for reducing rates of antibiotic prescription and to thereby reduce rates of antibiotic-related harms, particularly bacterial resistance, is … substantial,” Del Mar and his colleagues concluded. “Our data provide the basis for setting absolute targets for reducing antibiotic prescribing in Australian general practice.

“Had GPs adhered to the guidelines, they would have prescribed antibiotics for 0.65–1.36 million ARIs per year nationally, or at 11–23% of the current prescribing rate,” the authors wrote. “Antibiotics were prescribed more frequently than recommended for acute rhinosinusitis, acute bronchitis/bronchiolitis, acute otitis media, and acute pharyngitis/tonsillitis.

“Diagnostic uncertainty — concern by the treating doctor that a serious infection or complications might be missed — is one potential explanation for this finding.”

The authors said that their findings were the first to quantify the overprescribing of antibiotics in Australia.

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