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'One in five' GP antibiotic prescription is inappropriate, claims PHE

Public Health England has announced an ambition to cut GP antibiotic prescribing over the next two years, after research concluded one in five scripts could be inappropriate.

The PHE-commissioned research, published in The Journal of Antimicrobial Chemotherapy, found that between 8% and 23% of all antibiotic prescriptions in primary care were inappropriate, while one-third of all antibiotic prescriptions lacked an informative diagnostic code.

In the announcement, PHE said that 'at least' 20% of all antibiotic prescriptions written in primary care in England are inappropriate and that it wanted to halve that number to 10% by 2020.

The RCGP responded to the findings stating that while they are disappointing, they must not be used as an excuse for criticising GPs.

The researchers highlighted that the majority of antibiotic prescriptions were for infections of the respiratory and urinary tracts, and that rates varied substantially between practices.

The paper said: ‘Most antibiotics are prescribed for conditions that only sometimes require antibiotic treatment, depending on patient-specific indicators.'

When looking at actual versus ideal prescribing, researchers found that 'substantially higher proportions of consultations resulted in an antibiotic prescription than was deemed appropriate according to expert opinion'.

The team saw that antibiotics were prescribed in 41% of all acute cough consultations, despite experts advocating for 10%. For bronchitis this difference was 82% to 13% and sore throat was 59% to 13%.

They concluded that there is ‘substantial overprescribing of antibiotics in English primary care’, stating that this was most clear in respiratory tract conditions.

Professor Azeem Majeed, professor of primary care at Imperial College London, said that the findings were in line with prior research.

He told Pulse: ‘I think that for GPs some of the key messages of the paper include always trying to enter a suitable indication for an antibiotic prescription in the patient’s medical record and reviewing their use of antibiotics to ensure that they are prescribed when necessary and a that suitable antibiotic is used in line with local and national guidelines.'

He added: ‘There is going to be increasing scrutiny of antibiotic prescribing because of concerns about resistance and so it’s important that GPs show they are aware of the principles of good antibiotic stewardship’.

Responding to why some prescriptions could not be linked to a clinical diagnosis, he said: ‘This may be because the prescribing GP did not always code a diagnosis, for example, they may have put the diagnosis in free text rather than as a code.

'GPs sometimes also prescribe antibiotics after receiving a test result, such a urine sample showing an infection, and may not always enter a diagnosis when issuing a prescription.'

RCGP chair Professor Helen Stokes-Lampard said: ‘Today’s figures are extremely disappointing but they must not be used as an excuse for criticising GPs who are working their hardest to reduce antibiotic prescribing, whilst grappling with countless other workload pressures and a shortage of GPs.

‘If GPs do prescribe antibiotics, it is because, in their expert opinion, they are the most appropriate treatment available, given the unique circumstances of the patients before us. However we are still coming under considerable pressure from some patients who need to understand that antibiotics are not a "catch all" for every illness.'

Public Health England medical director Professor Paul Cosford said: ‘Using antibiotics when you don’t need them threatens their long-term effectiveness and we all have a part to play to ensure they continue to help us, our families and communities in the future.

‘This publication highlights the role GPs can play and I urge all practices to look at ways they can reduce their inappropriate prescribing levels to help make sure the antibiotics that save lives today can save lives tomorrow.’

Health secretary Jeremy Hunt said: ‘Drug-resistant infections are one of the biggest threats to modern medicine and inappropriate prescribing of antibiotics is only exacerbating this problem.

‘We are leading the world in our response - since 2012, antibiotics prescribing in England is down by 5% and we’ve invested more than £615 million at home and abroad in research, development and surveillance. But we need to go further and faster otherwise we risk a world where superbugs kill more people a year than cancer and routine operations become too dangerous.’

The Government first asked GPs to halve inappropriate prescribing of antibiotics in 2016, however at the time said it was not possible to put a definite figure on how many prescriptions are inappropriate and how many fewer prescriptions GPs would therefore need to prescribe to hit the new target.

Previous data showed there were about 34 million prescriptions for all types of antibiotics in 2015/16. If 20% were inappropriate, that would be 6.8m inappropriate prescriptions. If that number was reduced to 10%, it would account for 3.4m inappropriate prescriptions.

The Government launched the Keep Antibiotics Working campaign last year in an attempt to tackle the lack of patient understanding about when antibiotics are needed.

But a recent survey of GPs found that almost a third said that they had to frequently deal with angry or frustrated patients when they are told not to take antibiotics.

Readers' comments (25)


    What about antibiotic over use in agriculture...

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    define "inappropriate"
    without 20:20 hindsight

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    But a recent survey of GPs found that almost a third said that they had to frequently deal with angry or frustrated patients when they are told not to take antibiotics.

    Can we have placebocillin / placebomycin
    Indication.. inappropriate request

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  • I'm sure the microbiologists have some explanation for the link between me overusing amoxicillin in doubtful cases and the emergence the problem of multiple resistant infections /tb/quinolone resistant pseudomonas etc due to China's pig population being saturated with ciprofloxacin;
    But the older we get the more occasions we see when the decision not to use antibiotics led to complications eg child getting an empyema...and frankly this is not a time when we are inclined to avoid practising defensively!
    I think I really mean 'middle finger' in a more verbose way...

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  • Failure to prescribe could lead to you being prosecuted and total loss of income and loss of housing. You will be vilified globally and have a criminal record.

    Once we have justice for dr baba garwa then we can entertain these discussions.

    - anonymous salaried!

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  • I thought the hot topic was sepsis and DO NOT for one second delay prescribing abx?

    Also how can these great experts have any figures unless EVERY single person for whom abx were prescribed were cultured first to find out what they actually had? Or is that actual evidence-based practice and therefore forbidden by NHSE and our esteemed SOS.

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  • Not sure how they would audit this as how would they ever know what was inapprioate without even seeing the patient? Yes we should all be mindful of antibiotic use, but vets, agriculture and A & E would also be a good place to start.

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  • Lots going on here. Frequently patients expect a prescription as “they worked last time” and get upset when one isn’t prescribed. They can then “shop about” for another GP who will issue one. We are worried over missing something or a codition deteriorating and it coming back to us for not managing. Admittedly good record keeping will always back us up here.
    Where is the MASS media campaign. I’m not talking about a few bus stop posters. I’m talking about front line main stream media headlines educating people about the dangers of inappropriate antibiotic prescribing and the ability for people to self care for minor ailments.

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  • Boring. You are preaching to the choir. It’s well established that antibiotic prescribing is falling among GPs, offset by a wider rise in “primary care”. I’m responsible for my practice.

    Everyone else can get two digits rampant.

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  • 'Lack of informative diagnostic code' is a problem inherent in the clinical software systems, that NWIS should fix before blaming GPs.
    Sadly, the only software system that allows good coding and POMR is EMIS, which NWIS have just scrapped in favour of systems some of which at least offer worse coding ability - ie pour another crock of xxxxx onto the GPs trying to do a good job.
    The EMIS decision of NWIS needs urgently reversing. Where's the BMA again?

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