New report finds older Australians given more antimicrobials than wider community

While people in the wider Australian community are using antimicrobials less, a high level of these medicines are still being prescribed to people over 65. This level is even higher for older people living in aged care homes.

Antimicrobials include all antibiotics, antivirals, antifungals and antiparasitic agents. Antibacterial and antibiotic mean the same thing. They’re used to treat and prevent infections caused by bacteria.

Report findings

These important findings are from a new report by the Australian Commission on Safety and Quality in Health Care. The report, Antimicrobial use in the Community: 2023, analysed national data on dispensed prescriptions.

Data from the report shows an 11.1% increase in antimicrobial use in residents of aged care homes from 2022 to 2023. It also showed that almost three-quarters of residents were given at least one antimicrobial prescription in 2023.

The report found that people living in aged care homes are twice as likely to be prescribed a broad-spectrum antimicrobial than older people living in the community. The report also shows that cephalexin (a broad-spectrum antibiotic) was the antibiotic most often prescribed in aged care homes. This is even though it’s not the recommended antibiotic for common infections.

Antimicrobials and overuse

The more antimicrobials we use, and the more broad-spectrum they are, the more likely it is that microorganisms will develop antimicrobial resistance (AMR). AMR is a risk to people’s safety. It reduces the number of antimicrobials we can use to treat infections. This means that in the future there will be no effective oral antimicrobial options available. This will then mean more people will have to go to hospital for intensive treatment with broader-spectrum antimicrobials.

Unnecessary antimicrobial prescribing also puts people living in aged care homes in danger of serious risks including harmful drug effects like:

nausea
vomiting
clostridium difficile infection (a bacteria bug that causes an infection of the colon, the longest part of the large intestine)
drug interactions, that can happen between 2 or more drugs or with food and drink.

Taking action

We need to take action to reduce the level of antimicrobials and broad-spectrum antibiotics being given to aged care residents and older people.

Combined strategies of antimicrobial stewardship (AMS) and infection prevention and control are the most effective in reducing antimicrobial use. Which in turn prevents and controls AMR.

It’s important to make sure you use antibiotics appropriately and within the therapeutic guidelines (TG).

Appropriate prescribing means that:

antibiotics are only used for conditions where they’re likely to be effective
the narrowest spectrum antibiotic is used
the person receiving care understands the possible benefits and risks of antibiotics, as well as other options for treating their illness
antibiotics are used for specific periods, and if they’re prescribed for longer than recommended there’s a specific medical reason.

Key advice for providers, clinical staff and residential aged care AMS leaders

Monitor antibiotic use, especially for common infections.
Identify prescriptions that are outside of guidelines. For example, where cephalexin is prescribed and where the time of use is outside what is recommended by the TG.
Tackle inappropriate prescribing by identifying practices that contribute to it. For example:
- urine dipstick testing for residents with no symptoms of urinary tract infections (UTIs)
- identifying solutions such as staff education and feedback.

More information

We have resources to help providers and clinicians to review their AMS activities and create a thorough AMS program in their service:

Residential Aged Care Services tool (AMS SAT) and User Guide.
To Dip or Not to Dip (TDONTD) helps improve how you manage UTIs and reduces antibiotic use for UTIs in aged care.
To Dip or Not to Dip resources include an audit tool.

You can also find useful information in: