Antibiotic Use in Australia: A Mixed Bag of Progress and Persistent Challenges
Australia is grappling with a complex landscape of antibiotic use, with a recent report highlighting both improvements and significant areas requiring urgent attention. While the prescription of antibiotics in the community has seen a decline over the past decade, the nation’s hospitals and aged care facilities present persistent challenges in optimising their use and combating the growing threat of antimicrobial resistance.
Two experts deeply involved in antibiotic stewardship programs, primarily within hospital settings, have shed light on the implications of these findings. Their work focuses on enhancing antibiotic utilisation to improve patient outcomes and mitigate the rise of resistance.
Understanding the Threat: Antibiotic Resistance Explained
The importance of judicious antibiotic use and the fight against resistance cannot be overstated. The drivers behind antibiotic consumption differ significantly between hospitals and the broader community.
In hospital environments, clinicians frequently encounter patients with existing infections, including those that are already resistant to common treatments. This creates a delicate balancing act: ensuring critically ill patients receive prompt antibiotic therapy while simultaneously avoiding unnecessary prescriptions.
In the community, General Practitioners (GPs) must exercise considerable clinical judgment to discern whether an infection warrants antibiotic treatment or if a patient is likely to recover without it.
While the risks associated with inappropriate antibiotic use might seem minor at an individual level, the cumulative effect on a population scale is profound. Prescribing the wrong antibiotic, using them when they are not needed, or continuing treatment for too long significantly escalates the risk of antibiotic resistance. This phenomenon occurs when bacteria evolve mechanisms to evade the effects of antibiotics, leading to infections that are difficult, if not impossible, to treat with conventional options. This “selection pressure” allows resistant strains to flourish and spread.
Antibiotics in Surgery: Prevention Over Treatment
A significant portion of antibiotic use is associated with surgical procedures, primarily for infection prevention rather than treatment. Antibiotics are generally reserved for surgeries carrying a higher risk of infection and are typically administered for a short duration, often a single dose before the procedure or within 24 hours post-operatively.
However, the report indicates that nearly half (42.7%) of antibiotic prescriptions for surgical procedures were not deemed appropriate. Key areas for improvement include:
- Appropriate Indication: Ensuring antibiotics are only prescribed for surgical procedures with a recognised high risk of infection.
- Optimal Timing: Administering the antibiotic dose ideally within one hour before the surgical incision is made.
- Judicious Choice: Selecting an antibiotic that effectively covers potential causative organisms without being excessively broad-spectrum, which can increase side effects and promote resistance.
Inappropriate antibiotic use around surgery can have several negative consequences. Incorrect timing can diminish the antibiotic’s effectiveness. Prescribing for low-risk procedures or for extended periods unnecessarily exposes patients to potential side effects, such as diarrhoea, and contributes to the development of antibiotic resistance.
Aged Care Facilities: A Hotspot for Antibiotic Use
The report paints a concerning picture of antibiotic consumption in aged care homes, with residents receiving substantial amounts of these medications. Strikingly, a significant majority – four out of five residents (79.5%) – were prescribed at least one antibiotic annually. Furthermore, approximately one in three residents (34.7%) received antibiotics for longer than six months.
Residents of aged care facilities are inherently more vulnerable to infections, and the early signs and symptoms can sometimes be subtle and difficult to detect. While antibiotics can play a role in preventing infections in this setting, they should be considered a last resort. This is because infections that manage to develop despite preventative antibiotic use are more likely to be resistant to treatment.
Critical Antimicrobial Resistances: A Growing Concern
Beyond general antibiotic use, the report highlights a worrying increase in critical antimicrobial resistances. These are particularly dangerous microorganisms that pose a significant threat to the effectiveness of our last-line antibiotics, requiring specialised and intensive medical care.
The number of reported cases of these critical organisms more than doubled from 2022 to 2024, averaging over nine new cases each day. Compounding this issue, the report indicates that many of these resistant organisms are acquired overseas, underscoring the global and regional nature of the antibiotic resistance challenge.
Strategies to Combat Antibiotic Resistance
Addressing antibiotic resistance requires a multi-faceted approach. The latest report reinforces the need for several key actions:
- Public Awareness: Educating the public that many common infections will resolve on their own without the need for antibiotics.
- Aged Care Medication Reviews: Regularly reviewing medications for aged care residents, including antibiotics, to ensure their continued necessity.
- Optimised Antibiotic Use: Ensuring antibiotics are used more appropriately and for the shortest effective duration, supported by robust oversight in hospitals and at state and national levels.
- Surveillance: Continuously monitoring for infections caused by resistant bacteria to inform effective control strategies.
- Infection Prevention: Implementing measures to reduce the spread of resistant organisms within hospitals and the community.
- Broader Prevention: Promoting infection prevention through means such as access to clean water, sanitation, good hygiene practices, and widespread vaccination programs.
- Innovation: Continuing the development of new antibiotics and alternative treatments, ensuring appropriate incentives are in place to maintain a continuous pipeline of novel therapies.
A Coordinated National Response
This report provides a vital snapshot, but it’s essential to consider the broader context of antibiotic use in Australia. Previous estimations suggest that approximately 60% of antibiotics are used in animal agriculture. The recent use of florfenicol in Tasmanian salmon farms, an antibiotic closely related to the human drug chloramphenicol, exemplifies the interconnectedness of antibiotic use across different sectors.
This highlights the imperative for a coordinated strategy that spans human and animal health. Such a unified approach has proven effective in Australia in the past. Furthermore, treating antibiotic resistance with the same urgency and coordinated response as other major public health threats is crucial. The establishment of the Australian Centre for Disease Control, officially launched in early 2026, is expected to strengthen national efforts in this critical area.
