Abstract
BackgroundIt is commonly recommended that microbiological assessment should accompany the use of antibiotics prone to resistance. We sought to estimate the rate of microbiology testing and compare this to dispensing of the World Health Organization classified “watch” group antibiotics in primary care.MethodsData from a cohort of older adults (mean age 69 years) were linked to Australian national health insurance (Pharmaceutical Benefits Scheme & Medicare Benefits Schedule) records of community-based antibiotic dispensing and microbiology testing in 2015. Participant characteristics associated with greater watch group antibiotic dispensing and microbiology testing were estimated using adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CI) in multivariable zero-inflated negative binomial regression models.ResultsIn 2015, among 244,299 participants, there were 63,306 watch group antibiotic prescriptions dispensed and 149,182 microbiology tests conducted; the incidence rate was 0.26 per person-year for watch group antibiotic dispensing and 0.62 for microbiology testing. Of those antibiotic prescriptions, only 19% were accompanied by microbiology testing within − 14 to + 7 days. After adjusting for socio-demographic factors and co-morbidities, individuals with chronic respiratory diseases were more likely to receive watch group antibiotics than those without, e.g. asthma (aIRR:1.59, 95%CI:1.52–1.66) and chronic obstructive pulmonary disease (COPD) (aIRR:2.71, 95%CI:2.48–2.95). However, the rate of microbiology testing was not comparably higher among them (with asthma aIRR:1.03, 95%CI:1.00–1.05; with COPD aIRR:1.00, 95%CI:0.94–1.06).ConclusionsPriority antibiotics with high resistance risk are commonly dispensed among community-dwelling older adults. The discord between the rate of microbiology testing and antibiotic dispensing in adults with chronic respiratory diseases suggests the potential for excessive empirical prescribing.
Highlights
It is commonly recommended that microbiological assessment should accompany the use of antibiotics prone to resistance
We examined the number of prescriptions of amoxicillin-clavulanate (ATC code J01CR02), the main broad-spectrum beta-lactam antibiotic outside the watch/reserve group dispensed in Australia during 2015 from the Pharmaceutical Benefits Scheme (PBS) database, since for many conditions prescriptions of this antibiotic would require accompanying microbiology testing [10]
There were fewer than five reserve group antibiotic prescriptions; they were included in the watch group analyses; and in the following text, we refer to the group as watch group
Summary
It is commonly recommended that microbiological assessment should accompany the use of antibiotics prone to resistance. We sought to estimate the rate of microbiology testing and compare this to dispensing of the World Health Organization classified “watch” group antibiotics in primary care. To guide the use of antibiotics, the World Health Organization (WHO) proposed a three-category antibiotic classification system in 2017 [4]: namely access, watch, and reserve group antibiotics. Access group antibiotics are the first-line choices for common infections; watch group antibiotics are those with greater potential for developing resistance; and reserve group antibiotics are those considered “last resort” antibiotics for infections. WHO recommends that antibiotics in the watch and reserve groups (see Supplementary Table 1) should be limited to particular conditions and need special stewardship and monitoring [4]. Clinical guidelines for antibiotic prescribing in these countries do not recommend them as the first choice for empirical therapy for common conditions in the community, e.g. respiratory tract infections, skin/ wound infections, and urinary tract infections [8,9,10]
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