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    General practice pharmacist scheme evaluation indicates ‘improved capacity’ as the main benefit

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Umesh Modi is a chartered accountant, and Pamini Jatheeskumar is a chartered certified accountant at Silver Levene...
  Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead...
Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead pharmacist, Health and Wellbeing Directorate, Public Health England
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nice antibiotic researchAugust 19 2105

NICE has issued a new guideline to tackle the problem of inappropriate antibiotic prescribing.

Its guidance, NG15 - ‘Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use’, “aims to change prescribing practice to help slow the emergence of antimicrobial resistance and ensure that antimicrobials remain an effective treatment for infection.”

Announcing the guidelines, NICE said that part of the problem of increasing antimicrobial resistance stems from the discovery of new antibiotics being at an all time low. However, GPs’ prescribing was also a significant problem.

“Despite considerable guidance that prescribing rates of antibiotics should be reduced, 9 out of 10 GPs say that they feel pressured to prescribe antibiotics, and 97 per cent of patients who ask for antibiotics are prescribed them,” it said. If NG15 is implemented fully, NICE believes inappropriate antimicrobial prescribing could be reduced by 25%, representing 10 million fewer prescriptions each year.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: “Antibiotics are prescribed in circumstances when they are unlikely to do the patient much good. Knowledge amongst GPs is well established that many patients with early or benign infections do not require and will not benefit from antibiotics.”

While the “vast majority of GPs will tell patients that,” data shows that not all do: “I don’t think there is a lot of bad practice in general practice but it is clear that the reduction in antibiotic prescribing that we expected to see when our 2007 guideline on upper respiratory tract infections was published has not happened,” said Prof Baker.

“The rise in inappropriate prescribing comes in the face of successive attempts by NICE and by government to reduce it that simply haven't worked. Some of it is about the pressure put on GPs. Despite that pressure, prescribing an antibiotic when you know it’s unlikely to do the patient much good is not good practice.”

Doctors’ representatives from the BMA had an “urgent” meeting with NICE soon after the guideline’s announcement to raise their concerns about the criticism. Dr Chaand Nagpaul, BMA GP committee chair said afterwards: “We are pleased that following our meeting, NICE has clarified that inappropriate prescribing is not widespread amongst GPs and have made it clear that they wish to support all GPs, and not admonish them in public.”

The guideline also calls on other health professionals to help explain the benefits and harms of immediate antimicrobial prescribing as well as alternative options such as ‘watchful waiting’ and delayed prescribing.

Royal Pharmaceutical Society President Ash Soni commented: “Better stewardship of antibiotics has a vital role to play in reducing unnecessary antibiotic use. All prescribers need to be vigilant and ensure all treatment options have been considered before antibiotics are prescribed.

“The vast majority of antibiotics are prescribed outside of hospitals, usually by GPs. What’s also required to meet the antibiotic challenge is increased support for GPs and patients from other community health care professionals so we are all taking the same approach to prevent antibiotic overuse.

“Pharmacists are already playing their part at the point of dispensing in educating and advising patients about how to take antibiotics correctly. For example, it's essential to always finish a prescribed course of antibiotics otherwise bacteria can become more drug-resistant.”

Mr Soni also advocated greater use be made of minor ailment services operating in community pharmacies, but added that provision of such services is limited with only around a third of pharmacies in England commissioned to do so.

“The RPS wants to see a nationwide Minor Ailment Service through community pharmacies in England which could proactively help reduce the risk of over-use of antibiotics by tackling minor health problems before they are needed,” he said.

Links:

NICE announcement     

NICE NG15         

RPS response   

BMA response

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