GPs are set to conduct diagnostics in their practice to test whether infections are bacterial or not, under proposals from the chief medical officer to reduce broad-spectrum prescribing of antibiotics and reduce the ‘catastrophic threat’ of antimicrobial resistance.
Dame Sally Davies has called for the Government to introduce technologies such as molecular testing into practices so that GPs can move away from empirical treatment of infections and reduce their use of broad-spectrum antibiotics.
Dame Sally also said current education on infectious diseases and antimicrobial resistance was ‘woefully inadequate’ and called for Health Education England and the Royal Colleges to ensure that current and future doctors are educated in appropriate prescribing.
The recommendations were part of 17 made in the second volume of her annual report, which took a ‘deep-dive’ look at infectious diseases and antimicrobial resistance. The report will be followed by a risk strategy, which will lay out the action the Government will take to halt the rise of antimicrobial resistance.
The report called for antimicrobial resistance to be put on the national risk register, and to be raised on the international level at the G8 and World Health Organisation.
Launching the first part of the report, Dame Sally said: ‘Antimicrobial resistance poses a catastrophic threat. If we don’t act now, any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can’t be treated by antibiotics. And routine operations like hip replacements or organ transplants could be deadly because of the risk of infection.’
She added that the need for testing in GP practices was particularly important in children, as currently only a small proportion of all children presenting with fever have bacterial infections and the vast majority suffer from trivial, self-limiting, viral infections.
She said: ‘We want speedy diagnostics - a quick turnaround, ideally in the GP practice.’
Pulse understands that this would mean the introduction of diagnostics, such as molecular diagnostic testing, in GP practices to rapidly differentiate between viral and bacterial infections, and identify the bacterium involved to provide more targeted treatment.
Answering a question on the problem of pharmaceutical companies, whose motive to sell antibiotics to make profit is at odds with the call to use them sparingly, she said that in future they may need to be developed on a public basis.
Professor Davies said that infectious diseases have a total societal cost of £30 billion in terms of NHS costs, costs to the economy in terms of days off sick and intangible costs in terms of the pain and suffering caused to the individual.
She added that antimicrobial resistance was ‘doubling mortality’ as of the 5000 patients dying from gram negative infections, half were resistant to antibiotics.
‘That’s why governments and organisations across the world, including the World Health Organization and G8, need to take this seriously,’ she said.
RCGP chair Professor Clare Gerada said: ‘Patients have come to rely on - and expect - antibiotics for common colds and infections that will get better naturally or respond better to other treatments and this can make it difficult for GPs to prescribe appropriately.’
‘The College has been working for some time to reduce the unnecessary prescribing of antibiotics. Prescribing has been designated a clinical priority and we have already produced a wide range of resources, including a toolkit with the Health Protection Agency and free online learning - to support GPs in this area.’
‘The Chief Medical Officer’s report and recommendations will help this work and we particularly welcome the emphasis on training and continuing professional development for health professionals.’
‘Antibiotics can achieve excellent results if prescribed and used appropriately but patients need to be more aware of their drawbacks and this report will help GPs to get this message across.’
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