Recent trends in the prescribing of cholesterol lowering drugs in Australia. A report from the Drug Utilization Subcommittee of the Pharmaceutical Benefits Advisory Committee.

OBJECTIVE: To determine the recent pattern of use of hypolipidaemic drugs in the Australian community. DESIGN: Drug utilisation study employing prescription data collected during the operation of the Australian Pharmaceutical Benefits Scheme (PBS). SETTING: Non-hospital drug use in Australia. PATIENTS: All patients, pensioners and non-pensioners, who received prescriptions for hypolipidaemic agents under the PBS between January 1987 and December 1989. MAIN OUTCOME MEASURES: The total number of prescriptions, average quantity dispensed with each prescription, defined daily doses (DDD) and Australian population figures for pensioners and non-pensioners were used to express the consumption of hypolipidaemic agents as DDD/1000 individuals/day. RESULTS: Between the March quarter 1987 and the December quarter 1989 prescribing of hypolipidaemics for the Australian community increased from 68,120 to 304,760 prescriptions per quarter, which translates to a rise in use from 1.2 to 5.2 DDD/1000 inhabitants/day. This included a rise in the use of clofibrate from 0.6 to 2.6 DDD/1000 inhabitants/day, and of cholestyramine from 0.6 to 1.9 DDD/1000 inhabitants/day. Prescribing of hypolipidaemics for pensioners increased from 29,569 to 123,440 prescriptions per quarter. This translated into a rise in use from 3.7 to 14.8 DDD/1000 pensioners/day. Notable rises were seen for clofibrate, 1.9 to 8.1 DDD/1000 pensioners/day, and cholestyramine, 1.6 to 4.7 DDD/1000 pensioners/day. In comparison published data from the Nordic countries and the United States showed a lower overall use of hypolipidaemics and declining consumption of clofibrate. CONCLUSIONS: The trend in Australia was unusual in that the use of clofibrate increased to a greater extent than that of the resins, cholestyramine and colestipol which are generally preferred for treatment of hypercholesterolaemia. Possible reasons for this include: the better tolerability of clofibrate; its readier availability during the study period; the recommendation by the Pharmaceutical Benefits Advisory Committee that clofibrate was the preferred drug when triglyceride levels were also elevated and the limited availability of newer hypolipidaemic agents.

Profiles of antibacterial drug use in Australia and trends from 1987 to 1989. A report from the Drug Utilization Subcommittee of the Pharmaceutical Benefits Advisory Committee.

OBJECTIVE: To survey the use by Australian pensioners of orally administered antimicrobial agents supplied through the Pharmaceutical Benefits Scheme over the years 1987-1989. DATA SOURCES: Australian Pharmaceutical Benefits Scheme pensioner data for 1987-1989 and market research data from a private company. DATA EXTRACTION: The data were initially available as the number of prescriptions dispensed and were aggregated on a quarter year basis. These were converted to defined daily doses (DDDs) per 1000 pensioners per day (DDD/1000 per day). This conversion of the data allows comparisons across drug groups, and with prescribing patterns in other countries. The DDD/1000 per day also gives an indication of the proportion of individuals in the community receiving a drug at a particular time. DATA SYNTHESIS: There was a 26% increase in antibacterial drug use over this period. Comparison of prescribing profiles for particular indications with peer consensus guidelines revealed marked discrepancies, particularly for upper respiratory tract infections, urinary tract infections, otitis media and sinusitis. Upper respiratory tract infections accounted for 31% of instances of antibiotic prescribing. Dispensing of amoxycillin/potassium clavulanate relative to amoxycillin as a single agent, showed a marked increase in 1989 to the point where it represented 25% of all amoxycillin used. This could be considered excessive given the lack of evidence that amoxycillin resistance has substantially increased in infections presenting to general practice. The data presented here confirm previous suggestions that Australian antibiotic prescribing is heavily concentrated on the use of broad spectrum agents. By comparison with Norway or Sweden, there is a greater relative use of broad spectrum penicillins and tetracyclines and a lower relative use of phenoxymethylpenicillin and trimethoprim. CONCLUSIONS: Antibiotic prescribing practices in Australia continue to be often inappropriate and expensive, being directed too heavily towards the use of broad spectrum agents and newer more expensive drugs. Correction of such antibacterial drug use will require coordination of educational and regulatory activities that are sensitive to the context of general practice.