Control of fluoroquinolone resistance through successful regulation, Australia

Abstract

Fluoroquinolone antimicrobial drugs are highly bioavailable, broad-spectrum agents with activity against gram-negative pathogens, especially those resistant to other classes of antimicrobial drugs. Australia has restricted the use of quinolones in humans through its national pharmaceutical subsidy scheme; and, through regulation, has not permitted the use of quinolones in food-producing animals. As a consequence, resistance to fluoroquinolones in the community has been slow to emerge and has remained at low levels in key pathogens, such as Escherichia coli. In contrast to policies in most other countries, this policy has successfully preserved the utility of this class of antimicrobial drugs for treatment of most infections.

Figure 1

Data from Drug Utilization Sub-Committee Drug Utilization Database on Pharmaceutical Benefits Scheme and the Repatriation Pharmaceutical Benefits Scheme (RPBS) on subsidized medicines and estimates of non-subsidized medicines. RPBS data were calculated from continuous data on all prescriptions dispensed from a validated sample of community-based pharmacies. In-patient hospital prescribing is not included. Usage rate calculated on the basis of medication use of 1,000 persons per day. DDD, defined daily dose.

Figure 2

Quinolone use data for Europe from the European Surveillance of Antimicrobial Consumption initiative for antibiotic use in ambulatory care settings and European Antimicrobial Resistance Surveillance System. Use data for Australia from the Australian Group on Antibiotic Resistance (community isolates) and Drug Utilization Sub-Committee Drug Utilization Database (Commonwealth of Australia). Line represents logit-modeled relationship between resistance and usage, weighted by number of isolates tested. Usage rate calculated on the basis of medication use of 1,000 persons per day. DDD, defined daily dose; E. coli, Escherichia coli.