Prescribing decisions
Information to guide prescribing decisions.
Antibiotic prescribing guidelines
Antibiotic prescribing guidelines should be used in all health care settings where antibiotics are prescribed.
The Therapeutic Guidelines: Antibiotic was produced by the Antibiotic Expert Group of Therapeutic Guidelines Limited. The guidelines represent the best available evidence and opinion regarding antibiotic treatment in Australia. They guide prescribers on antibiotic treatment, including:
- choosing the best antibiotic
- correct dose
- when and how it should be taken
- how long it should be taken.
In some settings, there are local guidelines to guide decision making based on local or regional differences in resistance patterns.
The Australian Medicines Handbook is another important clinical resource that provides guidance on practical prescribing matters. These include contraindications, precautions, side effects and dose adjustments for specific populations.
Antibiotic stewardship tools and resources
Delayed prescribing
Delayed prescribing is when a doctor provides a patient with a prescription for an antibiotic but advises them to only fill it if:
- their symptoms continue
- their symptoms get worse
- the lab results show there is a bacterial infection.
In primary care settings, this is usually done for patients with acute respiratory infections.
Further information:
- Delayed antibiotic prescriptions for respiratory infections. This Cochrane review has shown that this method is safe and meets patients' needs.
- Is Australia ready to implement delayed prescribing in primary care? A review of the evidence. This Australian Family Physician article provides an overview of delayed prescribing.
- An interactive flow chart to guide antibiotic prescribing. This has been developed by the UK Government for self-limiting respiratory tract infections.
Shared decision making
Shared decision making is where a health professional and patient come to an agreed health decision after discussing:
- the options
- the benefits and harms of each option (informed by evidence)
- the patient’s values, preferences and circumstances.
Patient decision aids are a tool to help with shared decision making. Current research on patient decision aids shows that they help patients to:
- improve their knowledge of the options
- be clearer about what matters most to them
- have a better understanding of the possible benefits and harms of the options
- play a bigger part in decision making.
Further information:
- Strategies to reduce antibiotic prescribing for acute respiratory infections in primary care. This Cochrane review shows that shared decision making can reduce antibiotic prescribing for acute respiratory infections.
Decision aids on antibiotic use are available to support shared decision making for:
- sore throat
- acute bronchitis
- middle ear infection
You can find decision aids developed in Australia on the Australian Commission on Safety and Quality in Health Care website.
Further information to support the use of shared decision making:
- General practice patient charter: a guide for implementation. This publication from the RACGP provides guidance in helping patients make informed decisions.
- Shared decision making: what do clinicians need to know and why should they bother? This is a Medical Journal of Australia article.
- Resources and webinars to support shared decision making are available on the Australian Commission on Safety and Quality in Health Care’s website.
- Information about the benefits and harms of antibiotic prescribing for acute sinusitis and sore throat is available on NPS MedicineWise’s website.
Audit and feedback
Understanding your own prescribing data can help you identify areas where you might need to pay particular attention. Programs such as MedicineInsight can provide helpful data to prescribers.
The National Centre for Antimicrobial Stewardship is currently piloting the National Antimicrobial Prescribing (NAPS) survey in general practice.
Choosing Wisely Australia Initiative
Choosing Wisely Australia is an initiative which aims to:
- change attitudes and behaviours regarding the use of tests, treatments and procedures
- encourage medical professionals and patients and carers to talk about unnecessary tests, treatments and procedures
- support patients to make informed decisions
- improve stewardship of health care resources
- raise awareness that more isn’t always better when it comes to tests, treatments and procedures.
The Choosing Wisely website includes information and resources for health professionals about antibiotic treatment.
NPS MedicineWise
The NPS MedicineWise website includes a clinical topics page on reducing antibiotic resistance. The page includes topics related to antibiotics and antibiotic resistance as well as a list of CPD learning activities.
Patient resources
The following resources may help you to talk to patients about antibiotic resistance and when antibiotics are needed:
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What you can do: This fact sheet explains the actions everyone can take to reduce antibiotic resistance.
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The Respiratory Tract Infection Action Plan: This resource was developed by NPS MedicineWise. It provides options to help patient with acute respiratory infections who are not prescribed antibiotics.
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Childhood RTI Fact Sheet: What every parent should know (PDF, 298KB): This fact sheet was developed by NPS MedicineWise. It may help you to reassure parents about the expected duration of symptoms and how to identify signs of more serious illness. This may help managing their expectation for antibiotics.
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What every parent should know about coughs, colds, earaches and sore throats.
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Respiratory tract infections (RTIs) – nose throat and lungs.
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Choosing Wisely Australia provides information for patients and carers about antibiotics and antibiotic resistance.
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NPS MedicineWise provides important guidance on the correct use of antibiotics.