Azithromycin Ceftriaxone/cefotaxime Ciprofloxacin Shigella species Ampicillin Azithromycin Ciprofloxacin Co-trimoxazole Staphylococcus aureus Cefoxitin (MRSA) Ciprofloxacin Clindamycin (including inducible resistance) Co-trimoxazole Erythromycin Gentamicin Oxacillin (MRSA) Tetracycline Vancomycin Streptococcus pneumoniae (invasive) Benzylpenicillin Ceftriaxone/cefotaxime Meropenem Set 2: Organisms where the impact of resistance is substantial in hospital settings Acinetobacter baumannii complex Meropenem Enterobacteriaceae: Enterobacter cloacae and E. aerogenes Ceftriaxone/cefotaxime Ciprofloxacin Gentamicin Meropenem Pseudomonas aeruginosa Ceftazidime Ciprofloxacin Gentamicin/tobramycin Piperacillin–tazobactam Set 3: Organisms where resistance is a marker of epidemiological resistance and/or usage Campylobacter jejuni and C. coli Moxifloxacin Set 4: Organisms resistance will be monitored through passive surveillance, and that Clostridium difficile Moxifloxacin Streptococcus agalactiae Benzylpenicillin Clindamycin Erythromycin
Appendix A Benefits and limitations of types of passive surveillance data for antimicrobial use Data type Data sources (number of software systems) Benefits Limitations Amount prescribed Electronic prescribing systems (>10) Can link to clinical data (e.g. indication) Ability to use data to influence prescriber decision. More than 95% of GPs used these systems No standardised data structures or reports Stand-alone systems not centrally linked Not uniformly used for prescribing in Australia Manual prescription chart audit (0) Enables assessment of clinical appropriateness and context Manual data collection is time intensive and not ongoing NPS MedicineInsight (1) Will provide data from 300 representative GP practices Link to reason for use and pathology test orders Rollout is currently ongoing No AU reports yet data (1) Data from 100 consecutive consultations with 1000 representative GPs Not an ongoing data system Antimicrobial prescribing is not routinely surveyed Amount dispensed Statewide hospital pharmacy dispensing systems (ACT, NT, Qld, SA, Tas) (1) Extensive tracking of all hospital dispensing procurement and supply Data fields standardised within each state (e.g. iPharmacy feeds all Qld use data to MedTRx) Only in hospitals and only in some states Unable to report stock supplied on imprest (i.e. stored on ward for general use) Hospital pharmacy systems (NSW, Vic, WA) (>3) Extensive tracking of all hospital dispensing procurement and supply Stand-alone systems not centrally linked Hospital data not standardised Community pharmacy dispensing systems (>10) Extensive tracking of all community dispensing procurement and supply – including RACFs and private hospitals serviced by the community pharmacy Stand-alone systems not centrally linked
survey (0) Representative survey of community pharmacy dispensing Representative survey of only 500 community pharmacies Likely to underrepresent private Does not include pharmacies (e.g. discount chains) RACF Webstercare unit dose systems (1) Able to track dispensing Dose systems established RACF only Community systems vary and may not be compatible with the Webstercare Unit Amount procured or distributed Hospital pharmacy procurement systems (>3) Most comprehensive view of total amount procured (includes imprest stock) Unable to account for actual used (e.g. includes loss, discarded stock, ‘shrinkage’ [stolen]) Not linked to patient or ward use (i.e. unable to convert to DDDs) Wholesalers and manufacturers Provides gross national sales on AU Able to be compared internationally by manufacturers (i.e. allowing international comparison of drugs under patent) not directly linked to use (e.g. lag time from sale to use) Data not very granular (interpretation and use of data from analysis are limited) Data commercial in confidence and therefore not publicly available Limited manufacturer data with associated cost for reporting Amount administered to the patient Electronic administration systems (e.g. ICU and EMR systems) (>5) Contains extensive clinical data (for appropriateness of therapy and linking to AMR, etc.) Captures use in clinical Very limited clinical scenario Systems in limited use nationally (e.g. only used in individual wards) Manual medication administration audit (0) Enables assessment of clinical appropriateness and context Used by NAPS Manual data collection is time intensive and not always continuous (i.e. point prevalence) PGA