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PHE: GPs should ‘prescribe shorter antibiotic courses and educate patients’

GPs should prescribe shorter courses of antibiotics, with the expectation that patients will return if they are still not well, Public Health England’s antibiotics lead has said.

In an exclusive interview with Pulse, PHE’s Dr Susan Hopkins said the new focus in the fight against antimicrobial resistance was to ‘really push the idea that shorter courses are good’.

This followed recent PHE-commissioned research – published in the BMJ – that found GPs were often prescribing longer antibiotic courses than guidelines advise.

Dr Hopkins said if a patient is still ill following a shorter course of a few days, ‘then it’s about contacting the GP again, and [the GP] explaining that the likelihood is that if you’re not well three to four days into an antibiotic, that antibiotic’s not going to work’.

GPs have told Pulse the approach is ‘unrealistic’ and that returning patients will add to workload and contribute to longer appointment waiting times.

The RCGP stressed GPs have been successful in curbing antibiotic prescriptions, but that they will always prescribe a course of antibiotics based on patient need.

Dr Hopkins said: ‘The other thing we’re trying go doing now, on the back of the BMJ article, is to really push the idea that shorter courses are good.

She added: ‘This is really important because with the new NICE guidance that we’ve been developing – PHE and NICE – over the last three years now, we’ve really started to show where you could give no antibiotics, where antibiotics aren’t needed.

‘So commonly, antibiotics aren’t needed for otitis media and sinusitis for example, even sore throats – the majority of sore throats don’t need antibiotics – and then when you do need them, we’re asking people to prescribe the shortest duration possible.

‘And so in many situations that’s gone from prescribing seven to ten days of antibiotics, right down to five days, and even in some scenarios down to three days, for lower urinary tract infections – cystitis in women, for example.’

Dr Hopkins continued: ‘So we understand that it’s difficult for GPs – they can’t review those patients every day – but they can prescribe short durations, and basically if the patient’s not well after three or four days, then it’s about contacting the GP again, and [the GP] explaining that the likelihood is that if you’re not well three to four days into an antibiotic, that antibiotic’s not going to work, even if you’re giving it for longer.’

Commenting on the expectation that GPs will prescribe shorter courses, West Kent LMC representative Dr Zishan Syed said: ‘I think it’s very unrealistic. If you look at the current waiting times, it is not an exaggeration to say many patients are waiting on average three to four weeks for an appointment.

‘If we started telling people with these very common infections to come back, we would end up doubling that waiting time.’

RCGP chair Professor Helen Stokes-Lampard said: ‘GPs in the UK are doing an excellent job of reducing antibiotics prescribing overall – but our priority will always be the patient in our consultation room, and we will prescribe based on the unique combination of factors potentially affecting that patient’s health at that time.

‘This extends to the length of time we prescribe antibiotics for, in accordance with local guidance, and we would urge patients to take the full course of medication, as recommended by their doctor.

‘It’s important that any guidance that GPs use to inform their clinical decisions is evidence-based and updated in line with emerging research, and if guidance does change that this is communicated effectively with the profession.’

She added: ‘Growing resistance to antibiotics is a huge threat globally, and it’s essential we all – not just GPs and other healthcare professionals – work to curb it, by realising they are not a cure-all for every illness. But antibiotics are also important, life-saving drugs and it’s vital that doctors are not deterred from using them when they think it’s appropriate to do so.’