E-DRUG: Antibiotic repeat prescriptions to be restricted in Australia
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In Australia prescription formats are determined by the Pharmaceutical
Benefits Scheme (PBS). Doctors use computers with PBS software that
generate prescriptions according to the 'rules'.
For example if they wish to prescribe Amoxycillin 500 mg for a patient the
software will generate a written prescription for Amoxycillin 500 mg, 20
capsules, one to be taken three times a day and 1 repeat available
(together with all other needed details, patient name, doctor's name, date
etc) . The patient can access the repeat without going back to the doctor.
Many antibiotic prescriptions include the repeat option.
The AMA and RACGP are backing proposed restrictions
Repeats of four common antibiotics would no longer be funded via the PBS
under a new plan to tackle antibiotic resistance.
The PBAC proposal, released last week, [October 4] recommended banning
subsidies for repeat scripts of cephalexin, roxithromycin, amoxycillin and
amoxycillin-clavulanic acid.
The move was aimed at aligning public subsidies for antibiotics with
recommended lengths of treatment as set out in Therapeutic Guidelines and
?would support antimicrobial stewardship and quality use of medicine?, the
committee said.
The four antibiotics were targeted because they accounted for the highest
volume of dispensed repeats, the Department of Health added.
AMA president Dr Tony Bartone told Australian Doctor the restrictions were
necessary to stop patients squirreling away their repeats and using them
inappropriately at a later date. ?The Department of Health has very clear
data on the number of repeats that are filled asynchronously,? said Dr
Bartone, a GP in Melbourne.
?It?s a fairly significant proportion.?
A single script for antibiotics should reflect the recommended course
length, Dr Bartone said.
?Currently, Doctors may issue their repeats just in case the patient is not
better after the course. But at this point, it?s probably prudent for the
patient to be reviewed anyway. ?If they?re not recovering, maybe the
presentation is actually viral or maybe a different intervention is needed.?
The RACGP also backed the changes.
However, Associate Professor Mark Morgan, chair of the RACGP?s Expert
Committee ? Quality Care, pointed out that even some single packs of
antibiotics contained more medication than the recommended course length.
?I strongly think that pack sizes should match the recommended course
length, but I?m not sure that?s necessarily always the case at the
moment.?
If the plan went ahead, there would be rare cases where patients required
an extended course of antibiotics and would have to return to their GP for
a second script, he added.
But ?any inconvenience would be outweighed by the overall benefits?, he
said.
The proposal will go to the federal Minister for Health for approval, with
no firm deadline for his decision.
E-drug@healthnet.org