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Government to curb ‘just in case’ prescribing of antibiotics by GPs

just in case antibiotic prescribing

The Government has set out a new commitment to mitigate ‘just in case’ antibiotic prescribing in general practice as part of its strategy to tackle antimicrobial resistance.

Several new additions have been made to a revised national action plan that set out how the UK would achieve its ambition of containing and controlling antimicrobial resistance by 2040.

Among the 17 new commitments, the Government said it would ‘explore the extent of “just in case” prescribing in primary care of antimicrobials and the underlying causes’.

This would also involve steps to ‘test and implement interventions to mitigate just in case prescribing’, the update said.

There is also a new commitment to research the impact of Covid-19 on antimicrobial usage, prescribing, stewardship and resistance.

And it outlines a need to review the messaging on antimicrobial stewardship after the pandemic in order to highlight best practice.

In addition, the Government said there was a need for randomised controlled trials to compare length or duration of antibiotic courses in terms of clinical outcome and resistant micro-organisms.

Targets already set out in the current five-year plan which was launched in 2019, include cutting UK use of antibiotics in humans by 15% by 2024 and understanding the proportion of prescriptions which are supported by a diagnostic test or decision support tool.

The Primary Care Respiratory Society recently published a pragmatic guide to support point of care C-reactive protein testing as part of moves to cut antibiotic prescribing.

A study published last year found that delayed antibiotic prescribing is safe and effective for most patients with respiratory tract infections, even those in higher risk groups.

The report, which was published in the BMJ and based on studies of 56,000 people said delayed antibiotic prescribing could be used as a way of reducing antimicrobial resistance, particularly in primary care.

An analysis has previously shown that antibiotic prescribing in general practice fell by 17% between 2014 and 2018 in England but that antibiotic resistant infections had increased.

RCGP chair Professor Martin Marshall told Pulse: ‘Growing resistance to antibiotics is a serious threat to the long-term health of our patients across the country, and worldwide. It is something GPs take seriously, and good progress has been made in reducing antibiotics prescribing.

‘In the UK, GPs and other prescribers are always looking for ways to safely reduce patients’ use of antibiotics. We support any interventions that reduce anti-microbial resistance, and there is evidence that issuing “delayed” prescriptions of antibiotics can help, and it’s important this is considered as clinical advice and guidelines are developed.

‘The College welcomes the Government’s new commitments to the national action plan and the intention to revise it to reflect the impact of Covid-19. We have previously supported such approaches to prescribing and have worked with the UKHSA to develop the TARGET antibiotics toolkit to support GPs and our teams in the appropriate prescribing of antibiotics.’

READERS' COMMENTS [8]

Monica Stevens 8 June, 2022 10:17 am

The pendulum swings again !

We were exhorted to prescribe rescue antibiotics for all COPD patients to keep at home, but I found that the patient’s threshold for taking them was much lower than mine.

Like many things, if the antibiotics are easily available, they are taken just in case, but if the patient has to make an appointment and attend the surgery they are used more sparingly, and hopefully in the right circumstances.

David jenkins 8 June, 2022 11:44 am

and what about the orthopods – giving several grams of cephalosporins to joint replacement patients “just in case” ?!

and what about farmers putting antibiotics in cow feed to boost yield ?

Patrufini Duffy 8 June, 2022 4:13 pm

Hahha. Whilst hospitals use co-amoxiclav first line. You cant curb nothing. Patient wants it, they get it. GMC says, you didn’t give a delayed script with safety netting? Yes I did. And Cqc love a sepsis policy, but also an antimicrobial stewardship blah blah. Can’t have it both ways, unless you fancy that weird stuff. Sometimes you think people are just bored up there behind their zoom meetings.

Truth Finder 8 June, 2022 5:35 pm

Well said everyone. Political madness over clinical sensibilities.

Dylan Summers 8 June, 2022 5:55 pm

I’ve never received a complaint for any of the times I did prescribe an antibiotic.

All the medicolegal jeopardy relates to “failure” to prescribe.

David Church 8 June, 2022 9:36 pm

You know, it would help to preserve what little confidence GPs still have for the ‘Government’ or the upper echelons of NHSE if just occasionally they would find out what they are talking about before they blame GPs yet again for something that it is not us that does it.
‘Just-In-Case’ antibiotics (you know, the ones every patient with a hint of COPD or COAD, or frequent urinary problems is ORDERED by the hospital doctor – of these days the hospital Noctor – so that they can take them every time they think they might be about to develop a cold, sniffle, hayfever, of wish to avoid catching anything in the run up to a holiday/weekend/party/wedding) are extremely rarely ‘prescribed’ by GPs : it is hospital staff who PRESCRIBE and ORDER that they MUST be put onto patients’ repeats so that they can have them every 2 weeks……….
Any attenpt by GPs to ‘de-prescribe’ in cases of continuous use, is usually met with threats of legal claims or referrals to GMC because the ‘specialist says I must have them and that you should not depreive me of them’.
It is about time these hospital specialists took proper prescribing responsibility for their own prescriptions and signed off on these monthly (or every week), like a good doctor really should do for their own decisions.

paul cundy 9 June, 2022 7:05 am

Dear All,
Could they not look at other “just in case” services, like NHS111, just in case you might have something other than an utterly trivial unimportant self limiting non-illness, you should “contact a GP within 2 hrs”.
Regards
Paul C

Mark Essop 13 June, 2022 6:35 pm

I have never used delayed scripts because they just seem to be a method for placating patients instead of nailing your colours to the mast and saying they are not needed. Either a condition is bacterial or it isn’t. Telling a patient to take antibiotics if their sore throat doesn’t clear up in a couple of days is illogical because regardless of the cause the symptoms are likely to persist in that timeframe anyway.
Whilst the government is looking at antibiotic stewardship, maybe it should start by addressing the excessive use of chloramphenicol by pharmacists who eagerly sell it to anyone with a hint of an itchy eye.