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Antibiotic prescribing ‘increased by 40% in a decade’

Antibiotic prescriptions for coughs and colds increased by around 40% from 1999 to 2011, reversing a trend that had seen antibiotic use decline in preceding years, according to a study from public health officials.

Public Health England (PHE) experts said prescription rates were higher than they should be and the study ‘strongly suggests a need to make improvements in antibiotic prescribing’.

GP leaders called for greater efforts to inform patients and the public about the risks of inappropriate antibiotic use, and for GPs to resist pressure from patients for unnecessary antibiotic prescriptions.

The study by PHE and University College London researchers monitored trends in prescribing at 537 GP practices and whether antibiotic use agreed with current guidelines.

They found the proportion of patients prescribed an antibiotic for coughs and colds decreased from 47% in 1995 to 36% in 1999, but then rose again to 51% in 2011.

For sore throats, the proportion of patients prescribed an antibiotic fell from 77% in 1995 to 62% in 1999, and has broadly stayed the same since.

The researchers said the use of a recommended antibiotic for sore throats had increased from 64% in 1995 to 69% in 2011.

However, the team also found wide variation in prescribing rates, with some practices prescribing them for coughs and colds at twice the rate of the lowest prescribing practices.

Treatment with a short course of trimethoprim for urinary tract infections rose markedly, from 8% in 1995 to 50% of cases in 2011, but it varies considerably between practices, from 16% to 71%.

Lead author Professor Jeremy Hawker, consultant epidemiologist at PHE, said: ‘Although it would be inappropriate to say that all cases of coughs and colds or sore throats did not need antibiotics, our study strongly suggests that there is a need to make improvements in antibiotic prescribing.

‘Previous research has shown that only 10% of sore throats and 20% of acute sinusitis benefit from antibiotic treatment, but the prescription rates we found were much higher than this. The worry is that patients who receive antibiotics when they are not needed run the risk of carrying antibiotic resistant bacteria in their gut. If these bacteria go on to cause infection, antibiotics will then not work when the patients really does need them.’

The latest findings come after the RCGP suggested GPs should take ‘personable responsibility’ for educating the public about the risks of inappropriate use of antibiotics.

RCGP chair Dr Maureen Baker said: ‘Antibiotics are very effective drugs, as long as they are used appropriately. But we have developed a worrying reliance on them and GPs face enormous pressure to prescribe them, even for minor symptoms which will get better on their own or can be treated effectively with other forms of medication.

‘Our patients and the public need to be aware of the risks associated with inappropriate use of antibiotics and how to use them responsibly.  

‘This study reinforces the message that we issued recently for frontline health professionals to resist pressure from patients for unnecessary prescriptions and explore alternatives to them.’

J Antimicrob Chemother 2014; available online 5 August