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Kia āta kōwhiri Choosing Wisely

The Choosing Wisely campaign seeks to reduce harm from unnecessary and low-value tests and treatment.

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Antibiotics prescribed to nearly half of all people who visit a GP each year

Health Quality Intelligence
30 April 2019

New data shows 49 percent of those who visited their GP in 2017 were dispensed at least one antibiotic.

The data is part of the new Atlas of Healthcare Variation on community use of antibiotics released by the Health Quality & Safety Commission. It highlights variation in community antibiotic use, although it is not possible to know whether the antibiotic use was appropriate or not from these data.

Overuse of antibiotics is one of the causes of antimicrobial resistance, which is a problem worldwide. In New Zealand there is evidence of both under- and over-use and these data can be used to identify areas for further investigation.

Dr Sally Roberts, clinical lead for the Commission’s infection prevention and control programme, says that in New Zealand, up to 95 percent of antibiotics are dispensed in the community.

‘This suggests that a focus on promoting appropriate community use of antibiotics is an important way to address antimicrobial resistance.’

Antibiotic use was highest in those aged 0 - 4 years old, and those aged over 85 living in aged residential care.

Some antibiotics are prescribed more in winter than in summer, with 60 percent more antibiotics dispensed in winter for children under four years old.

‘These data may indicate that antibiotics are being prescribed for individuals with colds and flu, showing there is an opportunity to reduce antibiotics use,’ Dr Roberts says.

Of people dispensed penicillin, 83 percent received a broad-spectrum penicillin such as amoxicillin. Broad-spectrum antibiotics act against a wide-range of disease-causing bacteria and are therefore a particular risk factor for antimicrobial resistance.

‘Antibiotics are important, but it’s best to avoid prescribing broad-spectrum penicillins where possible. There’s an opportunity to raise awareness that amoxicillin is in fact broad-spectrum,’ Dr Roberts says.

The dispensing of antibiotics specifically indicated for urinary tract infections increased sharply with age and for people living in aged residential care. The rate of dispensing was three times higher in aged residential care than in the community.

Topical antibiotic use (antibiotics that are applied directly to the skin) has reduced over the last three years from six to four percent. The reduction in rates may reflect more appropriate use of these antibiotics.

Dr Roberts encourages primary health organisations and general practices to look at their data. ‘This is data for improvement - to help start a conversation about ways to address antimicrobial resistance.

‘Ask questions such as "Does this pattern of prescribing seem appropriate? Is it consistent with guidelines and are these regularly reviewed?".’

She says the data varies greatly between DHBs due to several reasons, including population and climate.

‘We recommend each area conducts further local analysis. The Atlas highlights variation but not the reason for this variation or what would be an appropriate level of prescribing in each setting.’

Australia has similar statistics on antibiotics, with 43 percent of the population being prescribed antibiotics in 2015. Amoxicillin and amoxicillin with clavulanic acid are also their most dispensed antibiotics.

Ministry of Health's chief pharmacy advisor, Andi Shirtcliffe, says the Atlas is a valuable tool that gives practitioners an insight to antibiotic prescribing in New Zealand and highlights how we use antibiotics across the country at a time when we're all cognisant of the risks of antibiotic resistance.

'We all need to be vigilant to ensure antibiotics continue to be the life-saving tool that we rely on to protect people's health and wellbeing. I encourage all practitioners to consider the data from this Atlas and review their own antibiotic prescribing.'

View the full Atlas here.

The Choosing Wisely campaign has these messages for health professionals about using antibiotics wisely.

When does a sore throat need an antibiotic?

  • In some people, especially Māori and Pacific children, sore throats can have very serious complications and do need antibiotics.
  • All sore throats in Māori and Pacific children and young people (aged 4–19 years) who are living in some parts of the North Island need to be checked straight away by a doctor or nurse.
  • Call Healthline 0800 611 116 if you are unsure what you should do.

This is because they are at risk of a serious preventable illness called rheumatic fever.  Sometimes a sore throat is caused by Streptococcus bacteria (strep throat). A strep throat can lead to rheumatic fever if it is not treated quickly with antibiotics. Rheumatic fever is a serious illness because it can cause heart damage.

Australasian Society for Infectious Diseases

  • Do not use antibiotics in asymptomatic bacteriuria.
  • Do not take a swab or use antibiotics for the management of a leg ulcer without clinical infection.
  • Avoid prescribing antibiotics for upper respiratory tract infection.

Australian and New Zealand Society for Geriatric Medicine

  • Do not use antimicrobials to treat bacteriuria in older adults where specific urinary tract symptoms are not present.

College of Intensive Care Medicine of Australia And New Zealand

  • Consider antibiotic de-escalation daily.

Internal Medicine Society of Australia And New Zealand

  • Once patients have become afebrile (non-feverish) and are clinically improving, don’t continue prescribing intravenous antibiotics to those with uncomplicated infections and no high-risk features if they are tolerant of oral antibiotics.

New Zealand and Australian Societies of Otolaryngology Head and Neck Surgery

  • Don’t prescribe oral antibiotics for uncomplicated acute discharge from grommets.
  • Don’t prescribe oral antibiotics for uncomplicated acute otitis externa.

New Zealand Dermatological Society

  • Don’t use oral antibiotics for the treatment of atopic dermatitis unless there is clinical evidence of infection.
  • Don’t routinely use topical antibiotics on a surgical wound.

Paediatrics & Child Health

  • Do not routinely prescribe oral antibiotics to children with fever without an identified bacterial infection.