The hard facts about Australia's antimicrobial use

Each year hundreds of people in Australia die as a result of drug-resistant infections, known as antimicrobial resistance, which is greatly worsened by misuse and overuse of antibiotics. Globally, WHO estimates that antimicrobial resistance could result in up to 10 million deaths each year by 2050.

The Australian Commission on Safety and Quality in Health Care (the Commission) has released its most recent report into the nation’s antibiotic use and resistance, revealing hopeful as well as concerning findings. ‘AURA 2023: Fifth Australian report on antimicrobial use and resistance in human health’ includes data and analyses from 2020–2022 (primarily 2020–2021) and reports on patterns and trends in Australian acute and community healthcare settings.

Encouragingly, the Commission reported an overall drop in Australia’s antimicrobial use of 18% since 2020. Last year, 21.8 million prescriptions for antimicrobials were dispensed in the community, down from 26.6 million in 2017. Reasons for this downward trend include policy changes in 2020 and physical distancing restrictions to reduce the spread of COVID-19 that led to a decrease in respiratory tract infections.

However, Australia still has one of the highest rates of antimicrobial use in the developed world, with one in three Australians (9.8 million people) having at least one antibiotic dispensed during the period analysed in the report. Last year, antimicrobial use was highest in Queensland, New South Wales and Victoria.

Australia ranks seventh highest compared with European countries, the United Kingdom and Canada in its use of antimicrobials in the community. Australian antimicrobial use in hospitals is estimated to be nearly three times that of the European country with the lowest use, the Netherlands.

Professor John Turnidge AO, Senior Medical Advisor for the Commission, said while the AURA 2023 findings were heartening, sustained changes are needed to preserve the value and potency of antibiotics.

“AURA 2023 highlights the need to get smarter about our prescribing of antimicrobials,” he said. “In the community and in aged care homes, we can ensure that prescribing for urinary tract infections, skin infections, chronic obstructive pulmonary disease and other respiratory infections is based on guidelines. Everyone has a role to play in this — doctors and other healthcare workers, as well as patients.

“In hospitals, we need to focus on appropriate use of antibiotics for surgical prophylaxis, manage the increase in organisms resistant to last-line antimicrobials such as carbapenemase-producing Enterobacterales (CPE) and monitor for emerging antifungal resistance.”

Turnidge cautioned that if antibiotics continue to be prescribed when they are not needed, medical procedures such as organ transplants, cancer chemotherapy, diabetes management and major surgery may not be able to be performed in the future.

“That is a bleak future that none of us wish to contemplate,” he said.

AURA 2023 showed that common pathogens such as Staphylococcus aureus (S. aureus), Escherichia coli (E. coli) and Neisseria gonorrhoeae (N. gonorrhoeae) are becoming increasingly resistant to major drug classes. Some organisms are even resistant to last-resort treatments such as CPE.

The report also highlighted several specific types of bacteria that are key emerging issues for antimicrobial resistance, including community-acquired methicillin-resistant Staphylococcus aureus (MRSA), E. coli and Clostridioides difficile infection (CDI).

“Antimicrobial-resistant germs pose an alarming health risk because in more serious cases when the drugs don’t work, there may be no antibiotic options left for some patients,” Turnidge said.

“Individual risks should also be considered, including the impact on the gut microbiome and emerging evidence that antimicrobial use may contribute to long-term chronic illness later in life,” he added.

“Antibiotics can save your life, so we should preserve them to treat life-threatening conditions — but we must not forget that they can also cause significant harm.”

The report’s release coincides with World AMR Awareness Week (18–25 November).

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