The match between common antibiotics packaging and guidelines for their use in Australia

Abstract

Objectives: To determine the potential for a source of surplus antibiotics in the community to come from the mismatch between the recommended duration of antibiotic treatment for common indications in primary care and that dictated by default pharmaceutical industry packaging. Methods: Analysis of existing published information of: 1) the most common antibiotics prescribed in primary care in Australia; 2) their most common indications; 3) the guideline recommendations for their duration; and 4) the duration dictated by antibiotic packaging. Results: Of 32 common antibiotic prescribing scenarios, 10 had doses left over in surplus and 18 had a shortfall, leaving only four in which the packaging size matched the duration recommended by electronic Therapeutic Guidelines. Where there was a shortfall, this was only exactly accommodated by a repeat prescription in two cases. Conclusions: Mismatch contributes to a shortfall or excess of doses compared to recommended antibiotic treatment protocols and probably exaggerates redundant doses in the community from prescribed antibiotics dispensed and not consumed. Implications: Prescribers need to be aware that the mismatch between antibiotic pack sizes and guideline recommendations for their duration is contributing to antibiotic resistance in the community.

Correlation of registered drug packs with Maastricht V/Florence Consensus Report and national treatment guidelines for management of Helicobacter pylori infection

“…Poor correlation of the size of drug packs has been previously discussed, for most frequent indications in primary care or antimicrobials that are greatly consumed. [2][3][4] These considerations should further be expanded to indications with great prevalence that are expected to have rising incidence or require combination antibiotic treatments.…”

“…Antibiotic resistance has been emerging worldwide . Patient behaviour, treatment adherence, leftover antibiotics and drug waste should be identified as potential targets for restraining antibiotic resistance, and these may be of greatest interest in primary care, outpatient setting or for infections with great prevalence . Considering the latter, it is estimated that 50% of the world's population will be infected with Helicobacter pylori .…”

Correlation of Recommendations of Treatment Guidelines and Frequently Prescribed Antibiotics: Evaluation of Their Pharmaceutical Pack Size

“…Evaluating the pharmaceutical packaging in Australia, McGuire et al . opine that there are no easy solutions to the leftover antibiotics problem as individualized packaging adds to the healthcare cost, especially when medicines are out‐of‐pocket expense for patients.…”

“…This creates the possibility of reusing the balance medication for future use, increasing the likelihood of the medication's misuse to treat non-susceptible organisms [8]. In addition, antibiotics are almost universally packaged by manufacturers in packs that are heavily driven by cost of economies and convenience rather than by any scientific basis or duration of therapy [10]. This prompted us to correlate the treatment guidelines with the choice of antibiotics and to assess whether packing size contributes to leftover dosing units when used according to guideline recommendations.…”

Reducing antibiotic prescribing in Australian general practice: time for a national strategy

“…More intractable problems include the dissonance between guideline‐suggested durations of antibiotic therapy and the pack size available on the PBS dispensed by pharmacists 18 . For example, for a child with acute otitis media requiring antibiotics, the duration recommended by the Therapeutic Guidelines 19 (ie, 5 days) means that a one‐year‐old child who weighs 10 kg and is prescribed a 100 mL bottle of 25 mg/5 mL of amoxicillin is left with two surplus doses.…”