6 5 Cellulitis/ Erysipelas 759 74.7 24.8 0.5 7 20 Appendicitis 159 76.7 22.6 0.6 8 9 Wound infection: surgical 369 74.5 21.4 4.1 9 10 Pneumonia: aspiration 362 77.1 21.3 1.7 10 8 Hospital-acquired pneumonia 401 77.8 21.2 1.0 11 17 Abscess 190 77.9 19.5 2.6 12 6 Sepsis: empiric therapy 563 80.8 17.1 2.1 13 15 Diverticulitis 219 85.8 14.2 0.0 14 14 Osteomyelitis 249 81.9 13.3 4.8 15 18 Sepsis: bacteraemia 188 87.2 12.8 0.0 16 19 Diabetic infection (including foot) 169 88.2 11.2 0.6 17 12 Sepsis: bacteraemia 261 89.7 10.0 0.4 18 13 Febrile neutropenia 258 92.6 6.6 0.8 19 3 Medical prophylaxis (bacterial, viral and fungal) 1320 89.9 6.4 3.6 20 11 Oral candidiasis 332 89.8 5.7 4.5 COPD = chronic obstructive pulmonary disease a Rank in the 20 most common indications, where 1 is the most common Source: National Antimicrobial Prescribing Survey, 2014 How appropriate is antibacterial use in the community? The NPS MedicineWise MedicineInsight program data showed that around 30% of people prescribed an antibacterial had an indication recorded for it in their medical record. Of these people, more than half of those who had colds and other upper respiratory tract infections were prescribed an antibacterial where none was indicated. Many people with acute tonsillitis, acute or chronic sinusitis, acute otitis media or acute bronchitis were prescribed an antibacterial even when such prescribing is either not recommended by or is not in line with Therapeutic Guidelines: Antibiotic recommendations (see Table 7). For example, 91% of people were prescribed an antibacterial for acute
pneumonia were for amoxicillin as by guidelines; all of these results were below the acceptable range (see Table 12). Table 11: Patterns of use, indications for prescribing, repeat prescribing, and differences between PBS/RPBS and private prescriptions for amoxicillin, 2014 Antibacterial (PBS/RPBS benefit) Patients issued a prescription (%)a Most common indications (%) Patient cohort Repeats prescribed Differences between PBS/RPBS and private prescriptions Amoxicillin (general benefit) 12.4 URTIs (30%) Otitis media (15%) infections (minority of cases) Highest use in children, and patients with COPD or asthma 27% of prescriptions ordered with one or more repeats Moderate variation between practices in repeats for URTI Negligible private use COPD = chronic obstructive pulmonary disease; PBS/RPBS = Pharmaceutical Benefits Scheme/Repatriation Pharmaceutical Benefits Scheme; URTI = upper respiratory tract infection a Percentage of patients who visited a GP at least once, or had one or more prescriptions in 2014 that were for the specified antimicrobial. Source: NPS MedicineWise MedicineInsight Table 12: Percentage of patients prescribed amoxicillin for select conditions, 2014 Condition Patient Number Percentage 95% CI Acceptable (%) Sinusitis (chronic or acute) than 18 years prescribed antibacterials 17 300 86 84–87 0–20 And prescribed the TG-recommended amoxicillin 5 607 32 29–36 80–100 Acute otitis media/myringitis Older than 2 years prescribed antibacterials 11 387 91 90–92 0–20 And prescribed the TG-recommended amoxicillin 7 154 63 59–67 80–100 Pneumonia Aged 18–65 years prescribed antibacterials 607 68 64–71 90–100 And prescribed the TG-recommended (for mild CAP – amoxicillin or doxycycline) 146 24 19–29 80–100 CAP = community-acquired pneumonia; CI = confidence interval; TG = Therapeutic Guidelines: antibiotic; URTI = upper respiratory tract infection Source: NPS MedicineWise MedicineInsight