For a long time now, the medical community has been aware of the growing threat of antimicrobial resistance and the grave implications this has. At Public Health England (PHE), we routinely collect data which show that resistant infections are becoming more prevalent. Recent examples such as the multi-drug resistant gonorrhea case seen in England demonstrate that antimicrobial resistance is not a future threat, but increasingly a problem for the present.
Naturally, given that primary care settings account for the majority of antibiotic prescriptions, we need GPs to lead the charge with reducing inappropriate prescribing. In the last 4 years, 3.7 million less antibiotics have been dispensed in England, with almost all GP practices making headway in reducing antibiotic prescriptions.
Despite this positive progress, research shows patients see a prescription as a sign that their condition has been taken seriously and this can lead to requests for antibiotics with little understanding that they may not be effective for their illness. For example, 38% of people who visit a doctor’s surgery, NHS walk-in centre or ‘GP out of hours’ service expect an antibiotic for a cough, flu or a throat, ear, sinus or chest infection.
Given patients’ expectation that they will be prescribed antibiotics, it’s not surprising that research shows that 20% of antibiotics are prescribed inappropriately, with a large disparity between the actual versus what experts consider ideal number of prescriptions. For example, over 80% of people were prescribed antibiotics to treat bronchitis between 2013 and 2015, but the ideal rate is under 15%.1
The campaign hopes to support the brilliant work GPs do by helping to explain the risks of antibiotic resistance
It is clear that there is still a job to be done to reduce patient expectations for antibiotics and in doing so, support the work of healthcare professionals to reduce inappropriate prescribing. PHE will soon be releasing the annual ESPAUR* report which provides a vital snapshot of antimicrobial resistance and antibiotic usage. To coincide with the ESPAUR report, PHE’s ‘Keep Antibiotics Working’ campaign will return, to alert the public about the risks of antibiotic resistance and to urge them to take their doctor’s advice on antibiotics.
The ‘Keep Antibiotics Working’ campaign launched in 2017 and has already started to change public perceptions about antibiotic resistance, landing the issue at a personal level. Post campaign research found that 78% of those surveyed stated that following the campaign they would be unlikely to ask for antibiotics.
To support GPs and other prescribers, PHE is promoting a new non-prescription pad for urinary tract infections, which joins the respiratory tract infection non-prescription pad that was widely used last year. The non-prescription pads – which provide a tangible alternative to antibiotics and can be personalised by the prescriber – provide patients with advice on how respiratory tract and urinary tract infections can be managed at home if antibiotics are not required.
Antimicrobial resistance is a very real threat and we all have a role to play in helping to tackle this looming crisis. The ‘Keep Antibiotics Working’ campaign hopes to support the brilliant work GPs do by helping to explain the risks of antibiotic resistance to the public, so they are primed to take their doctor’s advice if they are told antibiotics are not needed for their infection.
Dr Susan Hopkins is deputy director of antimicrobial resistance and healthcare associated infections at Public Health England
To download the free Treat Your Infection non-prescription pads and other resources to promote the ‘Keep Antibiotics Working’ campaign, including leaflets and posters, visit the PHE Campaign Resource Centre: https://campaignresources.phe.gov.uk/resources/
The TARGET Antibiotics Toolkit includes a range of resources that can each be used to support prescribers’ and patients’ responsible antibiotic use. The leaflets are available in 20 languages, including English, Arabic, Polish and Urdu on the RCGP website: http://www.rcgp.org.uk/clinical-and-research/resources/toolkits/target-antibiotic-toolkit.aspx
1. Public Health England. English Surveillance Programme for Antimicrobial Utilisation and Resistance Report (ESPAUR). 2018
2. McNulty, C et al. Public Health England and Capibus Survey. Attitudes towards antibiotics. 2017
3. Smieszek, T et al. Inappropriate antibiotic prescribing in English primary care. J Antimicrob Chem 2018; 73: ii36–ii43
4. Kantar Public. AMR Campaign National Rollout – Evaluation Debrief. March 2018.