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Delayed scripts cut antibiotic use by half

GPs can halve the number of patients taking antibiotics for upper respiratory tract infections by writing deferred prescriptions, a study reveals.

The vast majority of patients in the study were confident about making choices about their own treatment and would be happy to receive a deferred prescription again.

Researchers at Guy's and St Thomas's school of medicine in London suggested delayed prescribing 'could potentially address both the patient's expectation of an antibiotic prescription and the practitioner's clinical uncertainty'.

They sent questionnaires to 374 patients who were given deferred antibiotic prescriptions for URTIs at 13 group practices in the south of England to find out if they cashed in their prescription.

Almost half of the 256 patients who responded had not consumed antibiotics when contacted two days after their consultation and more than 90 per cent of those who returned questionnaires said they would choose to receive a delayed prescription again.

But 20 per cent of patients who did not consume their

antibiotics still collected the prescription, leading to fears over wasted money and stockpiling of drugs, the researchers wrote in the British Journal of General Practice (November).

URTIs currently account for about 50 per cent of antibiotic prescriptions in the UK.

Study leader Dr Martin Edwards, a GP in Forest Hill, south London, and honorary research fellow at the hospital, said: 'GPs frequently issue such prescriptions simply because they believe the patient expects it.'

He added: 'Part of this is a GP issue. Anecdotally, they seem to become more confident when they see patients who do not take the antibiotics and get better just as quickly.'

Dr Edwards said of the 20 per cent of patients who collected drugs but failed to consume them: 'That's not a huge reservoir. It is not infrequent you go to patients' houses and find they have got antibiotics from two months ago they never got round to taking.'

Dr Chris Cates, who successfully introduced delayed prescriptions at his practice in Bushey, Hertfordshire, said it was 'useful' to demonstrate that half of those asked to delay had not taken antibiotics, in an article also published in this month's BJGP.

His practice started withholding immediate antibiotics for children with acute otitis media in 1998. He said: 'In 1999 we published the initial results in comparison to a neighbouring practice, and showed a reduction of 32 per cent in cashed amoxicillin prescriptions in comparison to 12 per cent in the other practice.'

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