GPs should have lower threshold for antibiotic prescribing in elderly, says CMO

Clinicians including GPs should have a lower threshold for prescribing antibiotics in older people to prevent illness that can severely diminish quality of life, England’s chief medical officer has advised.

In his annual report – this year looking at infectious diseases – Professor Chris Whitty warned there is also a need to be more ‘systematic’ about preventing infections in older age groups who can ‘suffer significant harms’.

While the UK has become ‘extremely good at preventing child deaths, and indeed child significant ill health’ from infectious disease, ‘we still are left with a lot of deaths and a lot of disability from infections in older adults’, Professor Whitty said.

The impact of infection in later life, is ‘often not as appreciated in the medical profession as it should be’, including the link to cardiovascular disease.

‘There’s really very clear evidence now that having an infection increases your risk of a stroke’, across a whole range of infections as well as some suggestion the same is true for heart attack, he explained when launching the report.

‘My view is that we should be taking infections in older people much more seriously,’ he added and to not have an ‘across the board approach’ for all ages.

Antibiotic stewardship is of course essential, he added, but ‘in older people, the risks of an infection turning into sepsis are much higher, so the risk benefit is more in favour of treatment,’ he said.

The report said: ‘A low threshold for suspecting and treating infection in older people is warranted given they are at higher risk of severe consequences of infection.

‘This includes recognising that the balance point of benefit between antimicrobial treatment and stewardship is more likely to weigh in favour of treatment in older people where there is a higher degree of clinical uncertainty and a significantly greater probability of a poor outcome.’

Launching the report, Professor Whitty added: ‘We should have a lower threshold for treating with antibiotics in older than the elderly, compared to what we would have in the in younger people, where the risk benefit is really more against treatment antibiotics in most cases.’

The lengthy report also points to a drift downwards in vaccine uptake which ‘must’ be turned around.

Citing the near elimination of cervical cancer as ‘remarkable’ and ‘within our grasp’ but under threat by the drop off in vaccine uptake.

But he stressed that rather than vaccine hesitancy, access is a bigger driver of why someone may not have taken up the offer.

He said: ‘Actually, there hasn’t been much change in the least deprived, but there has been a general downward trend in the more deprived. And I think that tells us where it is we need to provide additional support.’

Infections in pregnancy and the neonatal period, remain a significant risk of harm, which needs to be addressed, he added, including through increased uptake of vaccines.

Protecting children against previously common serious infections through vaccination is ‘one of the greatest achievements of medicine’ which we must ‘not throw’ away by allowing uptake to fall, he added.

The report calls for continued innovation in developing new antibiotics to keep ahead of resistance.

He said the UK was one of the best positioned in Europe, on judicious use of antibiotics and it would be important to maintain ‘as we move antibiotics to be able to be prescribed more widely in pharmacies and so on’, with health care professionals being careful to follow the guidelines.

And Professor Whitty stressed that the UK needs to maintain its ability to respond ‘rapidly’ to future pandemics noting it was ‘very easy to let down our guard and disinvest between emergencies’ only to regret that later.

That should involve preparing for pandemics on the basis of route of transmission – for example, respiratory or vector-borne disease – rather than by specific infectious diseases such as flu or Covid, with ongoing assessment of the country’s capabilities.

Professor Susan Hopkins, chief executive of UKHSA, said: ‘Every epidemic and pandemic is a system test. Readiness is collective. When we maintain and strengthen the whole system, we improve health security and protect lives.’

Professor Andy Pollard, professor of vaccinology at Oxford University, said: ‘Our world-class NHS vaccination programme prevents thousands of life-threatening infections every year.

‘It protects our children from the daily threats posed by harmful bacteria and viruses and helps older adults stay healthier and out of hospital, freeing up vital capacity in an already stretched health system.

‘Vaccines act as a powerful shield, but the infections remain out there, which is why it’s essential that every person stays protected by vaccination.’