Understanding current antimicrobial prescribing practice in remote Aboriginal primary healthcare across northern Australia

The high burden of infectious disease and associated antibiotic use contribute significantly to the emergence of antimicrobial resistance (AMR) in remote Aboriginal communities. A better understanding of antimicrobial use in this setting is needed to inform decision-making at both a policy and clinical level. This pilot informs the longer-term aim of reporting on antimicrobial prescribing behaviour in this type of community setting with an audit plan that is relevant, feasible and sustainable. We adapted the National Antibiotic Prescribing Survey tool to audit current antimicrobial prescribing practice in Aboriginal Medical Services across northern Australia. Trained auditors reviewed clinic records at each clinic over a 1-3 week period recording data on the prescriber, treatment, indication and appropriateness of the prescription. 668 antimicrobial prescriptions were audited. Skin and soft tissue infections (SSTI) dominated as a reason for antimicrobial prescribing (WA: 35%; NT: 29%; QLD: 40%), with substantially more co-trimoxazole prescribed in far north Queensland. Compared with other settings in Australia, the appropriateness of prescriptions was mostly high. We found that this auditing process was technically difficult and time-consuming due to lack of existing framework, however, future developments in electronic prescribing and IT infrastructure will increase the feasibility of antimicrobial stewardship in this setting. This cross-jurisdictional collaboration supported emerging local stewardship programs and enabled identification of common priorities for Aboriginal & Torres Strait Islander health settings across northern Australia. Antimicrobial prescribing patterns clearly differ compared to other primary care settings. Context-specific antimicrobial stewardship tools and recommendations are needed to support best clinical practice and address rising AMR rates.