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Huge rise in antibiotic incentive schemes

By Lilian Anekwe

Exclusive: Half of PCTs are now running incentive schemes to cut GP antibiotic prescribing rates- with 40% of them set up in the past year - as trusts desperately try to tackle rising rates of antimicrobial resistance, a Pulse investigation has found.

The news comes as the first solid evidence linking antibiotic prescribing with resistance levels in the community emerges.

Responses to a Freedom of Information request from 116 English PCTs reveal that 56, or 48%, have such schemes with 40% set up in the past year as a direct response to concerns about rising antibiotic resistance.

Much of the focus is on broad-spectrum antibiotics like co-amoxiclav, cephalosporins, and quinolones – all linked to the rise in healthcare-associated infections Clostridium difficile and MRSA .

But macrolide antibiotics, including azithromycin – approved last year by the MHRA for sale over the counter – are also targeted in some schemes.

Some trusts are even insisting on a ‘no antibiotic or delayed antibiotic policy' for conditions such as respiratory tract infections, cough and bronchitis.

The scale of the clampdown emerged as results from a systematic review of 29 primary care studies were presented at the Society for Academic Primary Care meeting.

Researchers found the odds of a resistant infection were increased by 93% if patients had a prior prescription for a respiratory tract infection, and by 26% for prior antibiotics for urinary tract infections.

Overall, researchers found a clear ‘dose-response relationship', with one previous antibiotic course making it 2.5 times more likely for the patient to have a resistant infection and 3.4 times more likely after three or more previous courses.

The findings of the Pulse investigation divided opinion among GP experts. Dr Peter Fellowes, a member of the GPC's prescribing subcommittee and a GP in Lydney, Gloucestershire, said: ‘I think it's immoral to use financial incentive schemes in this way. It's a matter of education, not incentives.'

Professor Chris Butler, professor of primary care medicine at the University of Cardiff and a GP in Mountain Ash, Glamorgan, defended GPs. He told Pulse: ‘Many GPs are trying to keep patients out of hospital – in their mind they may be doing it for the right reasons.

‘Financial incentives might help with the easy cases. But for the real challenges what we need is better evidence – not just dangling financial incentives. This isn't the right way to change practice.'

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