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At the heart of general practice since 1960

Pharmacy contract sparks GP pay fear

Fears have resurfaced that GPs' success in cutting antibiotic use may have caused a big rise in

serious respiratory tract infections as new research shows

rising hospital admissions.

The news came as it emerged that a Government advisory body is commissioning research into the possible causal link between falling antibiotic prescriptions and the rising severity of respiratory illness.

But prescribing experts have dismissed the claims as 'extremely tenuous' and told GPs to continue cutting back on antibiotic use.

However, Professor Richard Wise, chair of the Specialist Advisory Committee on Antimicrobial Resistance (SACAR), said GPs should not start prescribing more antibiotics.

'All the work done in this area shows the same thing, that the decline in antibiotic prescribing might possibly be linked with some minor

increase in breakthrough infections,' he said.

'But the number of patients we would need to treat to avoid an incident is so large it shouldn't deter GPs from being judicious.'

However, Professor Wise said SACAR was planning a study to determine whether there was a causal link.

An analysis of prescribing data and hospital records by the Doctor Foster Unit at Imperial College, London, published in the BMJ (October 16), showed antibiotic scripts fell from 254 to 196 per 1,000 patients between 1996 and 2002.

In the same period the standardised hospital admission ratio for respiratory tract infections increased from a baseline of 100 in 1996 to 115 in 2002 with a peak in 1998 of 123.

The authors concluded that the fall in antibiotic prescribing rates was associated with a smaller corresponding increase in admission rates for respiratory tract infections.

Lead author Dr Paul Aylin, clinical senior lecturer in epidemiology and public health at Imperial College, agreed more data was needed to see if the link was statistically significant.

The new findings follow a study linking increased deaths from pneumonia with a substantial decrease in the number of prescriptions for antibiotics (Pulse, December 15, 2003).

Conflicting evidence on antibiotics

and respiratory illness

·July 2004 Evidence presented to the Society of Academic Primary Care shows antibiotics offer almost no

benefit to patients with acute lower respiratory tract infections (LRTIs).

·January 2004 Study published in Respiratory Medicine shows winter excess pneumonia mortality increased from 20.4 deaths per 100,000 to 30.7 from 1995 to 1999. Community antibiotic prescriptions for LRTIs fell 30 per cent over the same period.

·September 2003 A Health Protection Agency study prompts warnings that a high price is being paid for massive cuts in antibiotic prescriptions with pneumonia cases on the increase as a result.

By Emma Wilkinson

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