Abstract
Antibiotics are vital for treating bacterial infections in healthcare, but their use contributes to antimicrobial resistance (AMR), which poses a significant global health threat. In Aotearoa New Zealand (NZ), antibiotic usage rates in community settings are high. Surveillance of community antibiotic use is a valuable tool for supporting antimicrobial stewardship (AMS) programs, helping to optimise antibiotic use and mitigate the progression of AMR.
Aims
To describe the systemic antibiotic dispensing patterns in the NZ community from the 1st of January 2010 to the 31st of December 2019.
Methods
The study collected and analysed NZ community antibiotic dispensing data for the period between from January 1, 2010 and December 31, 2019. Community systemic antibiotic dispensing data was extracted from the National Pharmaceutical Collection, while population data was obtained from the Te Whatu Ora- Populations Web Tool. Two dispensing rates were calculated: the number of defined daily doses per 1,000 inhabitants per day (DID) and the number courses dispensed per 1,000 inhabitants per year, to measure community systemic antibiotic dispensing. Analysis was conducted considering antibiotic groups, the antibiotic AWaRe classification, District Health Board region where antibiotics were dispensed, and various patient characteristics, such as age group, sex, ethnicity, and
deprivation. Additionally, a multivariable analysis was conducted to explore the interactions between patient characteristics and community antibiotic dispensing rates during the study period.
Results
Overall, community systemic antibiotic dispensing rates in NZ declined over the study period. DID decreased from 20.4 to 19.9, and the number of courses dispensed per 1,000 inhabitants per year dropped from 867 to 767. While rates initially increased before declining, the trend varied based on measurement type: DIDs rose from 2010 to 2015 but decreased from 2016 to 2019, while the number of courses dispensed per 1,000 inhabitants per year increased from 2010 to 2012 before decreasing from 2013 to 2019.
Most antibiotic groups experienced decreased in dispensing, notably quinolones, although there were increase in certain antibiotics, particularly cefalexin from first-generation cephalosporins. Access group antibiotics saw an increase in dispensing while those in the Watch group declined.
Dispensing rates varied significantly by geographic region and patient characteristics. Rates were highest in the North Island, among children under five and females. Ethnic disparities persisted, with Pacific people having the highest and Asians the lowest dispensing rates, while Māori and the ‘Other’ ethnic groups showed relatively similar rates. Deprivation levels also played a role, with the most deprived group exhibiting the highest rates, while the least deprived group has the second-highest rate of courses dispensed. Multivariable analysis emphasised that the least deprived Pacific people had substantially higher dispensing rates compared to other demographic groups.
Conclusion and recommendations
The study indicates a decline in community antibiotic usage in NZ, reflecting global trends. Increased dispensing of Access group antibiotics and decreased dispensing of Watch group antibiotics suggest improved prescribing practices. However, significant disparities persist across regions and population groups, emphasising the need for targeted interventions. Regular surveillance on community antibiotic use is recommended to inform antimicrobial stewardship policies tailored to NZ’s context.