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Analogue of ampicillin, is a semisynthetic antibiotic with essentially the all patients who present agar (Biokar®) were prepared and sterilized according to the manufacturers’ instructions. Another drug and may not reflect the rates.

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In 2017, the General Practice National Antimicrobial Prescribing Survey (GP NAPS) identified several interventions to promote antimicrobial stewardship in general practice. One suggestion was to allow prescribers to review the maximum number of repeat prescriptions during electronic prescribing. Inappropriate repeat prescriptions typically occur inadvertently because many clinical software prescribing tools used by GPs have repeats ticked as a default setting for frequently prescribed antibiotics. The proportion of prescriptions issued with a repeat varies between different antibiotics, which is expected as some indications may appropriately require repeats.

For example, using doxycycline for the treatment of acne requires longer time frames. However, many common infections do not require repeat prescriptions and there is evidence supporting shorter antibiotic courses.

More than 26 million antibiotic prescriptions were dispensed through the PBS in Australia in 2017. In 2018, the Department of Health reviewed PBS listings of frequently used antibiotics that allowed repeat prescriptions to be issued as the default setting for computer-generated prescriptions. The aim of this review was to reduce antibiotic prescribing without impacting clinical decision making, by ensuring health professionals could actively decide to prescribe repeats for antibiotics where clinically indicated. The antibiotics selected for the review were the top five dispensed antibiotics on the PBS.

2 These antibiotics – amoxicillin, amoxicillin + clavulanic acid, cefalexin, doxycycline and roxithromycin – represented amoxicillin for chlamydia in males over 70% of all dispensed antibiotics under the PBS in 2017. The Pharmaceutical Benefits Advisory Committee (PBAC) noted that one in

five

repeat prescriptions of these antibiotics supplied through the PBS were dispensed more than 30 days after the dispensing date of the original prescription.

Alignment with Therapeutic Guidelines: Antibiotic (version 16) In April 2019, version 16 of the Therapeutic Guidelines: Antibiotic was published. The Therapeutic Guidelines: Antibiotic are a collection of guidelines published by an independent not-for-profit Australian organisation to provide clear, practical, evidence-based and up-to-date information to prescribers.

They are endorsed by reputable organisations and peak bodies, and used commonly in public teaching hospitals and community medical and pharmacy practices across Australia. The Department of Health review used version 16 of the guidelines to ensure changes and additions to PBS listings were in alignment.

At its August 2019 meeting, the PBAC considered the changes proposed in the PBS review of the selected antibiotics, which

included

: 2. implementing new Authority Required (Streamlined) listings to enable access to repeats for antibiotics prescriptions, where clinically indicated according to version 16 of Therapeutic Guidelines: Antibiotic amending the maximum quantity and repeats allowed for some listings to allow a patient to receive

the

full recommended course of antibiotic treatment for a particular indication as per Therapeutic Guidelines: Antibiotic; this is to be dispensed in one prescription for a short course of antibiotic treatment maintaining access to antibiotics for indications that are not listed in Therapeutic Guidelines: Antibiotic, without repeats, by maintaining or adding unrestricted listings for shorter treatment courses (with a note detailing that no repeats or increases in maximum quantity are allowed). These listing changes (summarised in Table 1 at the end of this article) encourage health professionals to use their clinical judgement to guide prescribing and allow them to prescribe repeats when clinically indicated. It should be noted that while doxycycline was considered in the review, no changes were made to its PBS listings because the indications and treatment periods of the listings were already in alignment with version 16 of the Therapeutic Guidelines.

Will the changes affect current prescribing services?

The amendments to repeats on antibiotic listings are expected to improve antibiotic use by reducing inadvertent repeat prescriptions, 2 and to assist in reducing antimicrobial resistance. The introduction of the Authority Required (Streamlined) listings is also expected to ensure that prescribers may still prescribe appropriate treatment courses when required, without significantly increasing prescriber workload.

If treatment courses exceed the limits of the PBS amoxicillin for eye infection listing, prescribers may still choose to prescribe longer courses, or for different indications, outside of the PBS. Patients who are prescribed shorter treatment courses may have to return more frequently than previously for clinical review, rather than taking more courses of antibiotics without review.

Before these changes, if mixing amoxicillin patients received repeats on their antibiotic script, they could continue taking the medicine for several weeks before returning to

see

their doctors.



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