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At the heart of general practice since 1960

'Say No to super-surgeries'

Debate over microbial resistance took centre stage this week as a study examined the impact of falling scripts and the first antibiotic was approved OTC ­ Cato Pedder reports

Dramatic cuts in antibiotic use appear to have caused the re-emergence of a serious childhood infection that all but vanished in the 1960s.

A Department of Health study has found a significant correlation between reductions in antibiotic prescribing and rising numbers of cases of mastoiditis, which can cause deafness or death.

The study, accepted for publication in the BMJ, was commissioned as part of a Government investigation into the consequences of cutting antibiotic use.

GPs said the findings highlighted the need for guidance on identifying and treating patients at high risk of serious infection.

Researchers analysed national prescribing data and found GP scripts for antibiotics fell by 37 per cent and scripts used by patients by 50 per cent over the last decade.

Over the same period, there was an excess 120 hospital admissions for mastoiditis.

Study leader Dr Mike Sharland, a consultant in paediatric infectious diseases at St George's Hospital, south London, said: 'It is a temporal association; we can't say whether it is a causal link, but it is interesting.'

Dr Sharland, chair of the paediatric sub-group of the Specialist Advisory Committee on Antimicrobial Resistance, said studies were needed to identify the children most at risk of developing mastoiditis.

But he stressed that GPs should not increase their antibiotic prescribing, as 2,500-5,000 children would need to be treated to prevent one case of mastoiditis.

Dr Angela Brueggeman, a senior research fellow at the Oxford Childhood Infection Group, said certain children might have factors ­ such as the shape the Eustachian tube ­ that made them more vulnerable to the infection.

Dr Mike Thomas, a GP in Minchinhampton, Gloucestershire, who has researched the impact of cuts in antimicrobial prescribing, said the study showed indiscriminate reductions could put some patients at risk.

'Appropriate reduction in antibiotic prescription is a good thing but it can't be a blanket policy. We need good clinical rules and bedside tests that can tell us which patients need antibiotics.'

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