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NICE to clamp down on antibiotic 'waste'

GPs face a clampdown in their use of common antibiotics for acne and conjunctivitis as part of a new NICE drive to cut health service costs.

The institute is to consult on guidance designed to curb the 'ineffective practice' of prescribing chloramphenicol and tetracycline antibiotics.

Health minister Andy Burnham requested the guidance in September last year. It is to

form part of a 'new programme of work to help the NHS ident-ify interventions that are not


Prescribing experts questioned the apparent double standards in restricting use of chloramphenicol in particular, given it is now available over the counter.

The drug has been available without prescription since June 2005, which NICE admitted 'may increase the use of topical antibiotics in the community independent of GP management strategies'.

The two guidelines will focus on use of chloramphenicol for treatment of suspected acute bacterial conjunctivitis and tetracyclines for acne vulgaris.

Oral antibiotics for acne vulgaris are being considered, the draft says, because 'although topical and oral treatment may be prescribed concurrently, concomitant use of different antibacterials is undesirable because of the increased likelihood of bacterial resistance'.

NICE insisted the guidelines would 'help the NHS make better use of its resources by reducing spending on ineffective treatments – that do not improve patient care or do not represent good value for money'.

But Professor Hugh McGavock, professor of prescribing science at the University of Ulster, said: 'It would seem to be counterproductive that GPs are being restricted while they remain OTC. There are major problems with regards to OTC prescribing.'

Professor Saad Shakir, head of the drug safety research unit and a GP in Dulwich, south-east London, said: 'I'd be interested to see what any guidance says about chloramphenicol OTC.'

Professor Shakir added that he thought GPs would benefit from guidelines in both areas to help them prescribe effectively, but in his experience most GPs did not overuse tetracyclines.

Waste not, want not

The CMO's 2006 plan to reduce 'variation in practice and deliver treatment equitably' could involve cutting spending on:

• Tonsillectomies

• Coronary revascularisation

• Statin prescription

• Hysterectomies in younger women

• Home haemodialysis

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