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GPs are likely to receive new guidance calling for swingeing cuts in antibiotic use after two major studies cast serious doubt on current practice.

A member of the Government's advisory committee on antibiotic use said the papers would be discussed at the next meeting with a view to revising guidance.

The first study, published in JAMA this week and first reported by Pulse a year ago, found antibiotics were of little or no use in treating acute, uncomplicated lower respiratory tract infections.

A second study, which appeared online in The Lancet this week and was covered in Pulse in April, found chloramphenicol was ineffective in children's conjunctivitis.

Professor Paul Little, leader of the LRTIs study and professor of primary care research at the University of Southampton, said: 'A lot of people are getting antibiotics for chest infections and it's probably not doing them much good. We probably should not be prescribing them.'

He said more research was needed to identify sub-groups that might benefit.

Dr Peter Rose, leader of the chloramphenicol study and lecturer in primary health care at the University of Oxford, said: 'This is a mild and self-limiting condition in primary care and does not need antibiotic treatment. It's sad we are continuing to medicalise a condition which is mild and self-limiting.'

Dr Douglas Fleming, a member of the Government's Specialist Advisory Committee on Antimicrobial Resistance and director of the RCGP's Birmingham research unit, said the studies would have an impact on guidance.

He told Pulse: 'I think both studies are encouragements for doctors to provide less antibiotics. GPs prescribe too many antibiotics. SACAR takes a note of all relevant papers and I'm sure at our next meeting it will be on the list.'

Further research published online by the BMJ this week found GPs had cut antibiotic prescribing by 50 per cent in the last decade without causing a proliferation of rare infections.

There were no increases in hospital admissions for peritonsillar abscess or rheumatic fever, although there was a 19 per cent rise in admissions for mastoiditis and simple mastoidectomy.

Dr Mike Sharland, lead author of the BMJ paper and chair of the paediatric sub-group of SACAR, said a new BNF for children would be published in the summer that would 'target antibiotic prescribing appropriately'.

By Nerys Hairon

'Chloramphenicol not effective for acute infective conjunctivitis'

Chloramphenicol was no more effective than placebo for treating conjunctivitis in children, with seven-day cure rates of 86 per cent and 83 per cent respectively. Even in children with an established bacterial infection, cure rates did not differ.

Researchers studied 326 children aged six months to 12 years from 12 UK general practices, randomising 163 to chloramphenicol eye drops and 163 to placebo eye drops.

Lancet June 22 early online publication

'Antibiotics of

little or no use

in LRTIs'

Immediate or delayed antibiotic use did not significantly reduce length of cough from a mean of 11.4 days in non-antibiotic controls. Antibiotics also had no effect of symptom severity.

Primary care researchers randomised 807 patients with acute uncomplicated LRTIs to immediate antibiotics, delayed prescription or no antibiotics.

JAMA 2005;293:3029-3035

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