Efforts to reduce unnecessary antibiotic use are working, with researchers from The University of Western Australia finding a decade-long decline in the number of antibiotics dispensed to Australian children.
Overuse or misuse of antibiotics is a key driver of antimicrobial resistance (AMR) – recognised by the World Health Organization (WHO) and governments globally as one of the world's most pressing public health concerns.
AMR, which renders once-reliable antibiotics ineffective, caused an estimated 1.14 million deaths worldwide in 2021 and is expected to claim 39 million lives and cost the global economy up to $10 trillion by 2050.
New research led by a team from UWA's School of Population and Global Health suggests Australian doctors are doing their part to reduce incorrect or over-prescription of antibiotics, with a significant drop in the number of antibiotics dispensed to children over the decade from 2013 to 2023.
In a paper published in Pediatric and Perinatal Epidemiology, researchers led by Dr Erin Kelty used data from the Pharmaceutical Benefits Scheme (PBS) to examine trends in antibiotic dispensing to children under the age of 13 during that period.
The team had access to 10 per cent of the PBS's full data set, allowing them to review more than 3.4 million antibiotic prescriptions dispensed to 554,837 children.
The study found there were 103 prescriptions dispensed for every 100 children in 2013, but by 2023 this had fallen to 63 per 100 children.
"The proportion of children dispensed with an antibiotic each year also decreased, with 45.7 per cent of children dispensed an antibiotic in 2013 compared with 33.6 per cent in 2023," Dr Kelty said.
The reduction was seen across sex, age and most antibiotic types, with the biggest drop in antibiotics classed by the WHO as 'Watch' medications – broad-spectrum antibiotics that are typically more costly and recommended for more severe conditions or infections from bacteria likely to be resistant to first-line options.
"Dispensing of 'Watch' antibiotics dropped substantially, decreasing by 15 per cent each year," Dr Kelty said.
"In 2013 these antibiotics represented 17 per cent of all antibiotics dispensed to children – by 2013 this had dropped to 6.4 per cent."
The study found the overall decline in dispensed antibiotic prescriptions had translated into millions of dollars in savings for consumers and the PBS, with the average prescription cost per 100 children dropping from $471 per year in 2013 to $274 in 2023.
"There were substantial reductions in both the total expenditure on antibiotics and the average cost per child, with a total saving of $669,509 per year between 2013 and 2023," Dr Kelty said.
"Given our results are based on a 10 per cent sample of PBS data, this reflects an estimated saving of approximately $6.7 million annually in dispensing of government-subsidised medicines in Australia from antibiotics alone."
The paper noted that while Australia had one of the world's lowest AMR-related mortality rates, its use of antibiotics exceeded many high-income countries, including the United Kingdom, Germany, Switzerland and Norway.
"Children receive more antibiotics than almost all other age groups," Dr Kelty said.
"This is partly because their immune systems are still developing, making them more susceptible to illness, but there can also be a lot of pressure on doctors to prescribe antibiotics for children, even when they may not helpful.
"Our findings do suggest, however, that efforts to educate parents, consumers and doctors around the importance of only using antibiotics when necessary are moving in the right direction, aligning with national public health goals to combat AMR.
"The reduction we've seen also means fewer children are being exposed to the risk of negative side effects that we know can be associated with antibiotics."
Co-author Ebony Quintrell, a PhD candidate with UWA and The Kids Research Institute Australia, said while the findings were good news for the global fight against AMR, more work needed to be done.
"Continuous monitoring of broad-spectrum antibiotics and dispensing trends will be crucial to sustain efforts to combat AMR, but we also need to get better at testing and identifying which bacteria, if any, is causing the problem, so we can prescribe antibiotics more effectively," Ms Quintrell said.
