How patients use repeat antibiotic prescriptions: the impact of dosing directions

Abstract

Background: Repeat prescribing of antibiotics is widespread in Australia. This may be associated with risks to individual patients and contribute to inappropriate antibiotic use.

Aim: To characterise the time intervals between dispensing of initial and repeat antibiotic prescriptions, and identify any associations between these intervals and information on treatment duration included in dosing directions.

Method: A retrospective study of de‐identified antibiotic repeat dispensing records from 186 Australian pharmacies.

Results: A total of 12 516 repeat dispensings for amoxicillin/amoxycillin (5198, 41.5%) and cefalexin/cephalexin (7318, 58.5%) were analysed. Of these, 50.7% (6340) and 78.8% (9863) were collected within 2 and 30 days of the date on which the original supply should have been completed, respectively. The remainder were dispensed throughout the following 11 months. Compared to prescriptions with no reference to duration or a generic statement regarding course completion, specifying a course length exceeding that provided by the initial pack was associated with a significantly shorter interval between the dispensing of original and repeat prescriptions.

Conclusion: Around half of all supplied repeats appear to be used to extend initial courses, while around 1 in 5 repeat dispensings occur at least 1 month after the initial prescription, suggesting that they may be used to treat separate episodes of infection. The inclusion of specific information regarding treatment durations on prescriptions and in dispensing directions appears to influence patient behaviour. While addressing the whole practice of issuing antibiotic repeats remains desirable, these findings may be relevant for prescribers and pharmacists, and help efforts to extend antimicrobial stewardship principles to the community.