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Antibiotic prescribing for LRTI 'could be halved'

By Emma Wilkinson

Antibiotic prescribing for patients presenting with LRTI symptoms could be slashed by half with no impact on outcomes, say researchers who are calling for antibiotic use to be standardised across Europe.

Their study of antibiotic use in 13 European countries – published in the BMJ - found massive variations in patients presenting with acute cough.

Wales and England were among the worst offenders with 60-70% of patients leaving their GPs with an antibiotic.

Slovakian GPs prescribed the most antibiotics at almost 90% and at the other end of the scale doctors in Barcelona, Spain only prescribed them for 20% of patients.

In the 3,400 patients with new onset or worsening cough taking part in the study, severity of symptoms was recorded by the clinician and in a 28-day diary by the patient.

Antibiotic prescribing in the study had little impact on recovery time or patient outcomes. The impact of antibiotic prescribing was statistically significant- but represented a tenth of a single percentage difference in symptom severity- an effect entirely consistent with a placebo effect, say the researchers.

Lead author was Professor Chris Butler, a GP in Mountain Ash, Glamorgan and professor of primary care medicine at Cardiff University. He said the lowest rate, in Spain, could be partly explained by the availability of OTC antibiotics.

But he said: ‘If you look at prescribing rates in Sweden or Norway- at 30% and 38%- and compare them with rates in the UK or Slovakia for instance, you see the outcomes were very similar.

‘We need to reduce the uncertainty of diagnosis. We're all worried about missing the patient with pneumonia but in our study this hardly happened. Prescribing antibiotics in patients who are otherwise unwell is more likely to do harm than good.'

Professor Butler's group is in the middle of a further study to see if particular patients, the elderly or smokers, would benefit from a prescription.

Dr Andrew Hayward, senior lecturer in infectious disease epidemiology at University College London, says that with other retrospective studies GPs might only make a note of an illness when they prescribe an antibiotic but that cannot be the case in this prospective study.

But he added: "There is some evidence that people are consulting less so it may be the people who are coming in are a bit more severe than they used to be."

Professor Butler's advice for GPs trying to cut down their antibiotic prescribing includes:

• Give patients a safety net

• Set realistic expectations

• Tell them even a bad cough usually passes in 3-4 weeks

• But to come back if they are short of breath, breathing fast, have chest pain or persistent fever

Antibiotic prescribing way higher in UK than other parts of Europe Antibiotic prescribing way higher in UK than other parts of Europe

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