A new report on antibiotic use in Australia has revealed that nearly half of all antibiotics prescribed around surgical procedures are inappropriate, highlighting ongoing challenges in combating antimicrobial resistance. Released recently, the findings from the National Centre for Antimicrobial Stewardship underscore a mixed progress in the country's efforts to curb overuse of these critical drugs, with improvements in community prescribing but persistent issues in hospitals and aged-care facilities.
The report, which analyzes data up to 2024, shows that while antibiotic prescriptions in the community have declined compared to a decade ago, hospital practices still leave room for enhancement. Experts involved in antibiotic stewardship programs, which focus on optimizing antibiotic use to improve patient outcomes and reduce resistance risks, emphasized the importance of these findings. "In hospitals, there are more patients with infections, and these are also places where patients come to with resistant infections," the experts noted, describing the delicate balance between prompt treatment and avoiding unnecessary use.
Antibiotics are commonly administered prophylactically during surgery to prevent infections, particularly in high-risk procedures. According to the report, they should typically be limited to a single dose before incision or up to 24 hours afterward. However, the data indicates that 42.7% of such prescribing was deemed inappropriate, often due to use in low-risk surgeries, incorrect timing of doses, or selection of overly broad-spectrum drugs.
The experts highlighted key areas for improvement: "only using antibiotics for surgery where there is a high risk of infection; the time we administer the antibiotic dose, ideally within an hour before the skin is cut; the choice of antibiotic – sufficient to cover the organisms that could cause infection, but not unnecessarily broad that it may cause side effects or antibiotic resistance." Inappropriate timing, such as administering the drug too early or too late, can diminish its effectiveness, while prolonged or unnecessary use exposes patients to side effects like diarrhea and accelerates resistance development.
This resistance arises through a process known as "selection pressure," where bacteria evolve to evade antibiotics, allowing resistant strains to proliferate. At the individual level, the risks might seem minor, but population-wide, they contribute to a growing crisis where common infections become harder to treat. The report's authors connected this to broader concerns, warning of a potential "post-antibiotic world" where even routine procedures could turn deadly without effective drugs.
Beyond surgery, the report sheds light on antibiotic use in aged-care homes, where residents face heightened infection risks due to age and health vulnerabilities. Strikingly, 79.5% of residents received at least one antibiotic prescription annually, and 34.7% were on them for more than six months. While prophylactic use can sometimes be justified as a last resort, the experts cautioned that it often leads to breakthrough infections that are more resistant. "Aged-care residents are at a higher risk of developing infections and it can sometimes be harder to spot the signs and symptoms of an infection," they explained.
The document also tracks the rise in critical antimicrobial resistances, defined as threats to last-line antibiotics requiring specialized care. These cases more than doubled from 2022 to 2024, reaching 3,389 incidents—or over nine per day. Many of these resistant organisms are acquired overseas, underscoring the global nature of the problem. The report emphasizes the need for coordinated international efforts to address this cross-border spread.
In the community setting, general practitioners play a pivotal role, relying on clinical judgment to avoid prescribing antibiotics for self-resolving infections. The decline in overall community use over the past decade is a positive trend, but the experts stressed that vigilance is essential. "If we think of this issue at the level of individual patients, the risks may feel small. But at the population level, using the wrong antibiotic, or using it when it's not needed, or for too long increases the risk of antibiotic resistance," they wrote.
The findings align with previous estimates that around 60% of Australia's antibiotics are used in animals, a sector not fully covered in this report but highlighted as crucial. Recent controversies, such as the use of florfenicol in Tasmanian salmon farms—a drug related to the human antibiotic chloramphenicol—illustrate the interconnectedness of human and animal health. The experts advocated for a "co-ordinated strategy across different sectors," noting Australia's past successes in similar public health initiatives.
To tackle these issues, the report recommends several actions. Raising public awareness that many infections resolve without antibiotics is key, as is regular medication reviews in aged care to ensure ongoing necessity. Hospitals should enhance oversight, using antibiotics judiciously and for the shortest effective duration. Broader measures include monitoring resistant infections to shape policies, preventing cross-transmission through hygiene, and investing in alternatives like vaccines and new drug development.
The integration of antibiotic resistance responses into the Australian Centre for Disease Control, officially launched at the start of 2026, could bolster national efforts. This move mirrors strategies for other public health threats, potentially streamlining surveillance and intervention. While the report provides a snapshot of human antibiotic use, it calls for comprehensive data across all sectors to inform policy.
Stakeholders in the medical community have welcomed the report's insights, though some hospital administrators note resource constraints in implementing stewardship programs. One unnamed official from a major Australian hospital said, "We're making strides, but the doubling of critical resistances is alarming and requires urgent funding." Patient advocacy groups echoed this, urging faster adoption of guidelines to protect vulnerable populations.
Looking ahead, the experts predict that without sustained action, the daily toll of resistant infections could climb further, straining healthcare systems. The report's release comes amid global calls for renewed antibiotic pipelines, with incentives needed to encourage pharmaceutical innovation. In Australia, where overseas travel contributes to resistance importation, public health campaigns may intensify to educate on prudent use during international trips.
Overall, the document paints a picture of progress tempered by persistent gaps, reinforcing that antibiotic stewardship is an evolving priority. As cases of hard-to-treat infections rise, the onus falls on healthcare providers, policymakers, and the public to collaborate. The experts concluded optimistically: "continue to develop new antibiotics and alternatives to antibiotics, and ensure the right incentives are in place to encourage a continuous pipeline of new antibiotics."
This comprehensive review serves as a call to action, reminding that curbing resistance is not just a medical imperative but a societal one, with implications for everyday health and surgical safety across Australia.