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Better diagnostics ‘unlikely to help GPs reduce antibiotic prescribing’

Giving GPs better diagnostic tests for infections is unlikely to help them cut down on antibiotic use and could even lead to increased prescriptions, Public Health England’s lead on tackling antimicrobial resistance has warned.

Dr Susan Hopkins, head of the English Surveillance Programme on Antibiotics Utilisation and Resistance at Public Health England (PHE) and a consultant in infectious diseases and microbiology at the Royal Free London hospital, said GPs needed help to determine a person’s risk of getting really sick rather than deciding whether they have an infection.

Speaking at PHE’s annual conference last week, Dr Hopkins said her team are currently looking at how antibiotic use in general practice can be further reduced by focusing on inappropriate prescribing, after GPs had cut down overall prescriptions by 7% over the past two years.

However, quizzed on the potential of diagnostics, Dr Hopkins responded: ‘No matter how good the diagnostic is, it’s never going to tell you whether it is or is not an infection. You more likely need some assessment of, “how likely this patient is to get sick if I don’t give them an antibiotic”.’

She added: ‘You would need a diagnostic with an excellent sensitivity – because otherwise [clinicians] will say, “oh but I could be missing something”.’

The Chief Medical Officer has previously called for GPs to get rapid diagnostic tests to help rule out bacterial infections and the need for antibiotics, as part of the drive to tackle antimicrobial resistance (AMR).

More recently, a Government commissioned review of AMR called for incentives for industry to develop better diagnostics for infections and some experts have called for wider use of the C-reactive protein test in general practice to help cut down on antibiotic use in respiratory infections.

Dr Hopkins said having more accurate diagnostics would be useful for some specific conditions, such as sexually transmitted infections, and sepsis, to make sure patients got the right antibiotic straight away.

But in primary care she said such tests could even lead to increased prescribing, by increasing the detection and treatment of infections in people who would have got better on their own.

Dr Hopkins explained: ‘If you give the example of sore throats – where we have the CENTAUR clinical system that tells you whether or not to prescribe – it’s likely that if we did the Strep test, we would have some people who did not hit CENTAUR criteria for prescribing but would be positive for Strep and would end up being given an antibiotic.’

GPs under pressure to restrict antibiotic use

GPs were recently praised for reducing antibiotic use ‘dramatically’, after hitting targets set for CCGs through the Quality Premium on reduced overall and broad spectrum antibiotic use.

However, they are still under pressure to cut their use even further – with stricter targets set through the Quality Premium this year – and a call from former Prime Minister David Cameron to ‘halve inappropriate antibiotic use by 2020’.

Pulse understands detailed research to determine how much of GPs’ prescribing is inappropriate is underway, with PHE aiming to set specific targets on this from April next year.


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