Topical antimicrobial prescribing patterns in residents of Australian aged-care facilities: use of a national point prevalence survey to identify opportunities for quality improvement.

Abstract

BACKGROUND\nAustralian residential aged care facilities (RACFs) are encouraged to participate in an annual Aged Care National Antimicrobial Prescribing Survey. This data source was analysed to describe patterns of topical antimicrobial prescribing and thereby provide insight into antimicrobial stewardship (AMS) changes that might be required.\n\n\nMETHODS\n2018 and 2019 survey data was analysed.\n\n\nRESULTS\nThe overall prevalence of the 52,431 audited residents (629 facilities) who were prescribed one or more topical antimicrobials was 2.9%. Of all prescribed antimicrobials (n=4899), 33.0% were for topical application. Most frequently prescribed topical antifungals were clotrimazole (85.3%) and miconazole (9.1%), and antibacterials chloramphenicol (64.1%) and mupirocin (21.8%). Tinea (38.3%) and conjunctivitis (23.8%) were the two most common indications. Topical antimicrobials were sometimes prescribed for prn administration (38.8%) and greater than six months (11.3%). The review or stop date was not always documented (38.7%).\n\n\nCONCLUSIONS\nTo reduce the possibility of adverse consequences associated with antimicrobial use, AMS programs in Australian RACFs should at least ensure mupirocin is appropriately used, first line antimicrobial therapy is prescribed for tinea, chloramphenicol is prescribed for conjunctivitis only if necessary, prn orders for prescriptions are discouraged and to avoid prolonged duration of prescriptions, review or stop dates are always documented.