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Amoxicillin overused for treatment of common infections, research shows

GPs may be overusing amoxicillin for some ear and respiratory tract infections, research suggests.

A study looking at types of antibiotics used in UK general practice found that inappropriate antibiotic prescriptions were most common in otitis externa and upper respiratory tract infections.

Data from more than a million consultations between 2010 and 2015 showed that amoxicillin accounted for 62.3% of prescriptions for otitis externa and 34.5% of prescriptions for URTI, despite not being recommended for these conditions.

However, inappropriate choice of antibiotic was low for sinusitis (2.2%), otitis media (3.4%), chest infections (1.5%) and urinary tract infection (2.3%), the study in the Journal of Antimicrobial Chemotherapy reported.

The researchers said that more work was needed to look into the variation they found between practices.

But they concluded: ‘Future antibiotic stewardship activities may focus on encouraging prescribers in primary care to reduce their use of amoxicillin in favour of appropriate narrow-spectrum antibiotics.’

Study leader, Dr Victoria Palin from the University of Manchester added that with greater availability of prescribing toolkits and focus on reducing antibiotics, prescribing may have improved in recent years but that it needed to be reviewed regularly.

She said: ‘A possible explanation may be related to diagnostic uncertainty.

'As diagnostic uncertainty is not uncommon when URTI is recorded as well as possibility of otitis media and otitis externa occurring together, this may partially explain the high prevalence of amoxicillin prescriptions for these conditions.’

Professor Azeem Majeed said there had been a decline in antibiotic prescribing in recent years so more up to date figures would be likely to show a lower use of the medicines overall.

But he added: ‘Amoxicillin is not generally indicated for URTIs, so I was surprised at the high level of use for this condition.

‘Also, I was surprised that for otitis externa, there seemed to be no recorded use of topical treatments.’

He said some decision support was now being built into electronic health record systems, which should help choice of the most appropriate antibiotic for a specific clinical condition and help clinicians keep track of various bits of guidance.

On improved antibiotic stewardship, Professor Majeed said system-wide approaches were important.

‘This would include for example, feedback of data on prescribing by CCGs to practices for specific infections and comparisons with other practices.’

Readers' comments (3)

  • David Banner

    Stop prosecuting us for “missing” sepsis, then we can talk. In the mean time they should focus on the gallons of antibiotics pumped into farmyard animals and EU countries were you can buy them OTC before shooting down GPs for giving Little Johnny amoxil for his earache. Perspective please.

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  • Got to admit that I sometimes am not sure whether a productive cough with a few crackles on the chest is an upper RTI or impending lower respratory infection, especially when the patient tells me that they feel a bit short of breath, off their food and fatigued. Throw Parapertussis and other atypical infections into the mix (which according to some studies are more common than suspected), and add to a huge cohort of frail, elderly multimorbid patients, and spice up with the very real threat of persecution for a delayed diagnosis of sepsis in the patient who deteriorated after you’ve seen them. I’m in awe of the experts who can advise with such certainty.

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  • doesn't say who prescribed them - GPs or noctors, OOH or other

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