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GPs urged to cut antibiotic use and focus on viruses

GPs are still overusing antibiotics and should cut back further on prescribing them, according to a leading GP researcher who advises ministers on the issue.

Dr Douglas Fleming, director of the RCGP's Birmingham research unit, was commenting on the latest data from the college's weekly returns service suggesting viral infections underlie cyclical patterns in respiratory disease.

He claimed many GPs 'completely underestimate the importance of viruses as a cause of significant disease'.

Addressing a Birmingham conference last week, Dr Fleming presented data showing bronchitis peaked every winter just before Christmas in children under five years old when respiratory syncitial virus was also known to peak.

Regular peaks just after New Year in patients aged 65 and older could also have a viral cause, he suggested.

Similar cycles were seen in upper and lower respiratory diseases and mid-winter peaks in incidence of respiratory disease in elderly patients were consistent with periods of influenza outbreaks (see graph), the data showed.

Dr Fleming, a member of the Department of Health's specialist advisory committee on antimicrobial resistance – which could make new recommendations on antibiotic prescribing later this month – said GPs needed to be educated to take viruses more seriously.

Dr Fleming questioned how many bacterial infections GPs would encounter if viral disorders were prevented or treated effectively.

'Lots of antibiotics are given on the grounds that they may be curative treatment but I suspect that very little is. A lot more attention needs to be given to treatment and prevention of viral illness,' he said.

Dr Mike Thomas, a GP in Gloucestershire and a hospital practitioner in respiratory medicine, agreed with Dr Fleming that viruses were the underlying cause of many respiratory illnesses. 'There's a lot of evidence that many respiratory infections start as a simple viral infection,' he said. 'As well as better education we need more research into the patterns of respiratory infections.'

Antibiotic prescribing: the background

September 1998 Standing Medical Advisory Committee report recommended urgent cuts in antibiotic prescribing.

September 2003 The Health Protection Agency published results showing that the rates of antibiotic prescribing had fallen significantly.

October 2003 A study by Dr Fleming showed that reduced prescribing was due to reduced disease rates.

December 2003 Chief Medical Officer Sir Liam Donaldson called for PCTs to have the right to challenge GPs' prescribing decisions.

March 2004 Standing Advisory Committee on Antimicrobial Resistance is evaluating evidence that deaths from pneumonia have increased due to reduced antibiotic prescribing.

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