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Antibiotic prescribing scheme helps cut C.difficile cases

By Lilian Anekwe

The levels of GP prescribing of high-risk antibiotics can be reduced by targeted primary care interventions, a new analysis reveals.

A new study found nearly three-quarters of GPs prescribed cephalosporins as first-line antibiotics, despite the antibiotic increasing the risk of C. difficile infection.

But by using several measures to control antibiotic prescribing, GPs were able to reduce prescribing of cephalosporins by a third, with a decrease in the number of cases of C. difficile infections also recorded over the same period.

Last month the Department of Health launched guidance on tackling C. difficile in the community, advising against inappropriate prescribing of high-risk antibiotics such as cephalosporins and quinolones, which have been linked with increased susceptibility to C. difficle infection.

Herefordshire PCT analysed prescribing of cephalosporins in 24 practices during the quarter ending 2007. Of 1,072 patients prescribed cephalosporins, 73% of prescriptions were first-line use.

Some 51% of prescriptions were for patients over 60 years of age and the same proportion were given for seven-day courses, despite both age and length of antibiotic course being risk factors for the development of C. difficile.

But after use of various educational interventions and prescribing interventions, a subsequent review of prescribing in February 2008 found GPs had reduced prescribing by 33% compared with the average PCT reduction of 10%.

The number of positive cases of C.difficile fell from 104 to 80 between the years ending September 2007 and 2008.

Dr Saran Braybrook, Herefordshire PCT pharmaceutical advisor, presented her research at the UK Drug Utilisation Research group conference in London last week.

She told delegates the PCT was planning further educational sessions and to benchmark practice prescribing data, and annual reviews of practice prescribing of high-risk antibiotics, including quinolones, were already underway. To ‘ensure a sustained change in prescribing'.

Dr Braybrook said: ‘This review highlighted issues such as inappropriate use of cephalosporins in URTI where sensitivity was at question as well as use outside of local guidelines.

‘This is a simple type of review that can be used across practices and PCTs. A multifaceted intervention, of which practice prescribing reviews is just part, is a key to implementing prescribing change in primary care.'

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