This coming week is ‘World Antimicrobial Awareness Week’. This global initiative aims to increase awareness of antimicrobial resistance and encourage best practices to reduce its spread. The theme for this year’s campaign is ‘Spread awareness, stop resistance.’
Antimicrobial resistance is one of the most significant healthcare challenges facing the world today. Antimicrobial-resistant infections are associated with a higher chance of a patient experiencing ineffective treatment, treatment toxicity, recurrent infection, delayed recovery, or death.
Antimicrobials include antibiotics, antivirals, antifungals, and antiparasitics. Resistance can develop to these agents when microbes change over time through mutation or gene transfer. These changes may enable the microbe to survive exposure to an antimicrobial that it was previously sensitive to. While antimicrobial resistance can develop naturally, the misuse and overuse of antimicrobials remains a significant contributory factor.
The COVID-19 pandemic appears to have had an interesting impact on antimicrobial use in Australia. The recently published AURA 2021 report (Antimicrobial Use and Resistance in Australia) reveals reduced dispensing rates for seven of the ten most commonly dispensed antibiotics. The greatest reduction was seen with amoxicillin (49% drop in use in April 2020). Significant reductions were also observed for amoxicillin with clavulanic acid, cefalexin, clarithromycin, doxycycline, phenoxymethylpenicillin, and roxithromycin. These agents are often used for the treatment of seasonal respiratory infections. The remaining three antibiotics that did not experience a significant decrease in use are those not typically used for upper respiratory tract infections (i.e., flucloxacillin, metronidazole, and trimethoprim).
The reduced dispensing of these antibiotics coincided with the implementation of pandemic control measures such as lockdown restrictions, an increased focus on hygiene and infection control, and increased use of telehealth services. It is thought that these efforts may have contributed to a decrease in seasonal respiratory infections. Data for the 2020 influenza season supports this hypothesis as laboratory-confirmed cases of influenza were around eight times lower in 2020 than the average for the preceding five years.
Some changes to the Pharmaceutical Benefits Scheme (PBS) listings may have also contributed to these results. In April 2020, the permissible number of repeat prescriptions reduced to zero for the five most commonly dispensed antibiotics: amoxicillin, amoxicillin with clavulanic acid, cefalexin, doxycycline and roxithromycin. Larger quantities of these agents are only available on authority prescription.
Similar reductions in antibiotic use over the pandemic have also been reported in other countries. This has highlighted the potential benefits of targeted interventions to maintain this trend. The Australian Commission on Safety and Quality in Health Care (the Commission) is currently exploring strategies to improve the appropriateness of antimicrobial use and maintain infection prevention and control measures. There will be a particular focus on upper respiratory tract infections, conditions that often do not require antimicrobial therapy.
The Therapeutic Guidelines: Antibiotic can be referred to for recommendations for the management of upper respiratory tract infections, including suggestions for symptomatic relief. For self-limiting viral illnesses, antibiotics are not indicated, although they are commonly used.
Further information on antimicrobial resistance and awareness initiatives can be found on the World Health Organization website.
- Australian Commission on Safety and Quality in Health Care. AURA 2021: fourth Australian report on antimicrobial use and resistance in human health. Sydney: ACSQHC; 2021.
- Department of Health. Australia’s National Antimicrobial Resistance Strategy – 2020 and Beyond. Canberra: Department of Health; 2019.