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Powerful antibiotic use urged after multi-resistance spreads to surgeries

A senior Government scientist has urged GPs to use powerful antibiotics to combat the spread of multi-resistant bacteria after revealing community-acquired resistant E. coli has reached GP surgeries.

Some 60 isolates of severe antibiotic-resistant infections ­ most from urinary tract infections but some from bacteraemias ­ have been identified at public health laboratories in the West Midlands and Surrey. GPs alerted the laboratories after spotting resistance in

patients.

Dr David Livermore, director of the Health Protection Agency's antibiotic resistance monitoring and reference laboratory in London, said each outbreak involved 'tens of patients'. The West Midlands outbreak involved many patients with the same strain of the infection, suggesting it was circulating in the community, he added.

The bacteria break down

?-lactam antibiotics and most are also 'broadly resistant'

to trimethoprim and fluoroquinolones.

Many PCTs now encourage GPs to limit their prescribing to older antibiotics in a bid to combat the growth of resistance. But Dr Livermore, a member of the Department of Health specialist advisory committee on antimicrobial resistance, said using older drugs was 'not a solution'. He urged GPs: 'Use antibiotics sparingly and use them only where necessary but where they are necessary use one that's powerful enough to work.'

He urged GPs to avoid using co-amoxiclav because of its 'borderline effectiveness' in resistant infections.

Dr Livermore said the outbreaks were perturbing. 'In E. coli 80-odd per cent are still susceptible to trimethoprim, 90 per cent to ciprofloxacin and 90 per cent to cephalosporins. When you see strains resistant to all these in hospital you blink ­ and when patients haven't ever been in hospital you blink twice.'

GPC prescribing chair Dr Peter Fellows said it was 'inevitable' resistant infections would reach general practice. Dr Fellows, a GP in Lydney, Gloucestershire, said: 'Use the cheapest and most accepted antibiotic that is likely to be effective. The more potent antibiotics should generally only be reserved for the more

serious cases.'

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