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a bacteria petri dish imageFebruary 28 2018

Figures showing that at least 20% of all antibiotics prescribed in primary care in England are inappropriate are “extremely disappointing,” the RCGP has said. However, it added: “Don’t blame GPs for high rates of antibiotic use — society must play its part.”

Public Health England has highlighted the data from five studies published as a supplement to the Journal of Antimicrobial Therapy. Findings indicate that “the majority of antibiotic prescriptions in English primary care were for infections of the respiratory and urinary tracts. However, in almost a third of all prescriptions, no clinical reason was documented.

“For most conditions, substantially higher proportions of GP consultations resulted in an antibiotic prescription than is appropriate according to expert opinion. An antibiotic was prescribed in 41% of all uncomplicated acute cough consultations when experts advocated 10%.”

Other inappropriate antibiotic prescribing levels included:

  • bronchitis (actual: 82% versus ideal: 13%);
  • sore throat (actual: 59% versus ideal: 13%);
  • rhinosinusitis (actual: 88% versus ideal: 11%);
  • acute otitis media in 2-18 year olds (actual: 92% versus ideal: 17%).

“Antibiotic prescribing rates varied substantially between GP practices, nonetheless, there is scope for all practices across the country to reduce their rates of prescribing,” said PHE.

Antibiotic prescribing has decreased by 5% since 2012, and the Government has invested £615 million in research, development and surveillance, both in the UK and abroad.

Responding to the findings, the RCGP’s Chair, Professor Helen Stokes-Lampard said: “Today’s figures are extremely disappointing but they must not be used as an excuse for criticising GPs who are working their hardest to reduce antibiotic prescribing, whilst grappling with countless other workload pressures and a shortage of GPs.

“If GPs do prescribe antibiotics, it is because, in their expert opinion, they are the most appropriate treatment available, given the unique circumstances of the patients before us. However, we are still coming under considerable pressure from some patients who need to understand that antibiotics are not a ‘catch all’ for every illness.”

Professor Stokes-Lampard warned that “antimicrobial resistance is now a major global health threat and responsibility for tackling this does not lie solely at the door of GPs – the whole of society must play its part.”

She pointed out that the RCGP has supported public health campaigns to raise awareness of the impact of antimicrobial resistance. It has also worked with PHE to develop the TARGET antibiotics toolkit, to support GPs and other healthcare professionals in the appropriate prescribing of antibiotics. It’s ’3 Before GP’ campaign was launched this winter to encourage the public to consider alternatives before visiting the GP with minor illnesses.

Professor Paul Cosford, PHE Medical Director, said: “This publication highlights the role GPs can play and I urge all practices to look at ways they can reduce their inappropriate prescribing levels to help make sure the antibiotics that save lives today can save lives tomorrow.”

Links:
PHE announcement     
RCGP statement          
Journal of Antimicrobial Chemotherapy, Vol 73, Issue supplement 2, February 2018. ‘Appropriateness of antibiotic prescribing in English primary care’.            

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