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Gold, incentives and meh

Pneumonia warning as GPs cut antibiotic prescriptions

Government scientists have hailed the massive strides taken by GPs to tackle antimicrobial resistance after research showed antibiotic prescribing rates plummeting.

But the findings from the Health Protection Agency study prompted warnings that a high price is being paid, with pneumonia cases on the increase as a result.

A team from the agency's West Midlands unit used national prescribing data to assess GPs' adherence to the landmark 1998 Standing Medical Advisory Committee report on antibiotic prescribing. GPs have made significant progress towards all four key SMAC recommendations, the researchers told the agency's annual conference last week.

The SMAC demand for a maximum three-day antibiotic course for uncomplicated cystitis has been heeded, with the proportion of such prescriptions soaring from 16 to 42 per cent between 1998 and 2001.

The rate of antibiotic prescribing for viral 'sore throats' crashed from 80 to 42 per 1,000 patient years at risk between 1995 and 1999 and has since remained static.

Prescribing for 'simple coughs and colds' also fell in the wake of the SMAC report, from 44 per 1,000 patient years at risk in 1993 to 23.5 in 1999. But rates crept up again to 30.5 by 2001.

There were also indications of a 'significant decrease' since 1998 in the proportion of phone consultations resulting in an antibiotic prescription ­ the fourth SMAC demand.

Study co-author Dr Gillian Smith, consultant epidemiologist at the agency, said GPs might be limiting antibiotics even more than suggested as they were only required to record 'significant diagnoses'.

Dr Mike Thomas, a GP in Gloucestershire and hospital practitioner in respiratory medicine, said GPs should be commended for heeding the Government demands, but he said the latest research suggested the SMAC advice may have gone 'too far' and at-risk patients presenting with 'coughs' were dying from pneumonia missed by GPs.

Dr Thomas, a clinical research fellow at the University of Aberdeen, said: 'It's quite possible patients with cough don't go and see the doctor because they've got the message it's self-limiting.'

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