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Antibiotic prescribing 'increased by 40% in a decade'

Antibiotic prescriptions for coughs and colds increased by around 40% from 1999 to 2011, reversing a trend that had seen antibiotic use decline in preceding years, according to a study from public health officials.

Public Health England (PHE) experts said prescription rates were higher than they should be and the study ‘strongly suggests a need to make improvements in antibiotic prescribing’.

GP leaders called for greater efforts to inform patients and the public about the risks of inappropriate antibiotic use, and for GPs to resist pressure from patients for unnecessary antibiotic prescriptions.

The study by PHE and University College London researchers monitored trends in prescribing at 537 GP practices and whether antibiotic use agreed with current guidelines.

They found the proportion of patients prescribed an antibiotic for coughs and colds decreased from 47% in 1995 to 36% in 1999, but then rose again to 51% in 2011.

For sore throats, the proportion of patients prescribed an antibiotic fell from 77% in 1995 to 62% in 1999, and has broadly stayed the same since.

The researchers said the use of a recommended antibiotic for sore throats had increased from 64% in 1995 to 69% in 2011.

However, the team also found wide variation in prescribing rates, with some practices prescribing them for coughs and colds at twice the rate of the lowest prescribing practices.

Treatment with a short course of trimethoprim for urinary tract infections rose markedly, from 8% in 1995 to 50% of cases in 2011, but it varies considerably between practices, from 16% to 71%.

Lead author Professor Jeremy Hawker, consultant epidemiologist at PHE, said: ‘Although it would be inappropriate to say that all cases of coughs and colds or sore throats did not need antibiotics, our study strongly suggests that there is a need to make improvements in antibiotic prescribing.

‘Previous research has shown that only 10% of sore throats and 20% of acute sinusitis benefit from antibiotic treatment, but the prescription rates we found were much higher than this. The worry is that patients who receive antibiotics when they are not needed run the risk of carrying antibiotic resistant bacteria in their gut. If these bacteria go on to cause infection, antibiotics will then not work when the patients really does need them.’

The latest findings come after the RCGP suggested GPs should take ‘personable responsibility’ for educating the public about the risks of inappropriate use of antibiotics.

RCGP chair Dr Maureen Baker said: ‘Antibiotics are very effective drugs, as long as they are used appropriately. But we have developed a worrying reliance on them and GPs face enormous pressure to prescribe them, even for minor symptoms which will get better on their own or can be treated effectively with other forms of medication.

‘Our patients and the public need to be aware of the risks associated with inappropriate use of antibiotics and how to use them responsibly.  

‘This study reinforces the message that we issued recently for frontline health professionals to resist pressure from patients for unnecessary prescriptions and explore alternatives to them.’

J Antimicrob Chemother 2014; available online 5 August

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Readers' comments (12)

  • to resist pressure from patients for unnecessary prescriptions and explore alternatives to them.’

    how do you do that when a complaint is lodged against a doctor for not providing abx. can we count on insititutions to defend us. when that happens - thought not. we all want to resist the pressure but nobody is defending GPs when they do. it's like batting grenades - RCGP has lost touch with its members completely

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  • This is what you get when you emasculate GPs and don't give them time to persuade the patient they do not need an antibiotic.

    We are encouraged to do telephone consultations because we do not have the capacity to see them. Why else do they ring ' for a chesty cough' - to be told they don't need any medication ? We are encouraged to give patients 'rescue' antibiotics if they have copd which they all take at the drop of a hat. We are told that uncomplicated uti just needs three day's worth of antibiotics, no need for msu. There are a lot of conflicting messages out there.

    The patient is king, the Department of Health told me so.

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  • This is pretty much what happens when you turn medicine into a popularity contest and give the patients - sorry customers - undue latitude to complain.

    This is why TripAdvisor (=F+F test) doesn't work for medicine. The general marker of a good hotel is giving the customer what they want. The general marker of a good doctor is giving patients what they need. They aren't always the same thing.

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  • It is pretty obvious why there have been increases in antibiotic prescribing yet none of them were addressed in the report.:
    1) - Time pressure
    2) - litigation
    3) - complaints
    4) - online reviews/ funding by satisfaction and now friends and family test.

    It is just much easier to say it is the fault of the GP.

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  • We need a government funded campaign about this with newspaper and television ads.
    The campaign needs to be semi permanent (a public information film or ad)
    Not only antibiotics but correct use of health services could be included - appropriate use of A&E, missing appointments, and other things I can't think of at this time.

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  • Another way to look at it would be to say that angry,demanding patients have increased by 40%!

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  • Friends and family test, patient questionnaires for revalidation, complaints handling, and lack of support in general for GP with the papers harking on about how little they know so the public think they know better...all ways to decrease antibiotics prescribing. Well done DOH and our BMA colleagues for fighting our corner. bravo.

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  • Its not the BMA's fault, they haven't helped. these issues are a reflection of social anxieties.

    We're trapped between trained to do the right thing and the move towards medical consumerism.

    Where we are we have may overseas (eastern European and subcontinent) patients who bring ab's from abroad - often they want the go ahead from us but we don't control access to ab's. only good thing - our prescribing figures looks artificially good.

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  • I agree with most people that when my prescribing is not as recommended then it is due to patient pressure. Even if I say Abx will so nothing you are fit and healthy your body will heal itself etc then I often get the answer "I want to give them a try anyway". I have had patients go to other gp's, ooh or A&E and be given Abx after I have declined, and next time come expecting them as the other ( read better) doctor gave me them. GP's do have a role to play but need other docs on board and need support that is more than a few posters in the waiting room.

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  • in my local ooh/ paediatric a/e antibiotics for obvious viral URTIs have become the accepted practice= so much so that reading the ooh/a/e attendance reports next day to see how many of our pts denied abx when they presented for a cold "chest Infection" pitch up and succeed in their endeavour..oh...and how often you see them a week later asking for a stronger one as the cough just does not seem to have gone.....

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