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GP antibiotic prescribing on the rise

5 August 2014

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GPs should not bow to “pressure to prescribe” antibiotics, experts have warned, in the face of new figures showing antibiotic prescription has increased by 40% over 12 years. 

GPs are still prescribing large amounts of antibiotics for viral illnesses such as coughs and colds despite government reduction goals. 

Through looking at prescribing trends at 537 GP practices, researchers found that between 1995 and 1999 the number of patients who were prescribed an antibiotic for a cough or cold fell from 47% to 36%. 

However, the number of prescriptions rose again to 51% by 2011. Some practices were prescribing at twice the level of the lowest prescribing practices. 

Prescribing for middle ear infections remained largely unchanged over the study period at 83% of cases. The study found that 10% of GP practices prescribed antibiotics to at least 97% of patients who presented with ear infections.

Prescribing for sore throats fell from 77% in 1995 to 62% in 1999 and then stayed broadly stable. However, the data from 2011 showed that among those patients receiving an antibiotic, over 30% received an antibiotic that was not recommended in the national guidance. Once again there was significant variation between practices ranging from half to nearly 4 out of 5 patients with sore throats being prescribed an antibiotic.

Recommendations on better prescribing by GPs, first made by the Department of Health in 1998, include:

 – No prescribing of antibiotics for simple coughs and cols

 – No prescribing of antibiotics for viral sore throats 

 – Limiting prescribing for uncomplicated cystitis to a three-day course of antibiotics. 

Professor Jeremy Hawker, a consultant epidemiologist in the field epidemiology service at PHE, who led the study, said: “Although it would be inappropriate to say that all cases of coughs and colds or sore throats did not need antibiotics, our study strongly suggests that there is a need to make improvements in antibiotic prescribing.

“Previous research has shown that only 10% of sore throats and 20% of acute sinusitis benefit from antibiotic treatment, but the prescription rates we found were much higher than this. The worry is that patients who receive antibiotics when they are not needed run the risk of carrying antibiotic resistant bacteria in their gut. If these bacteria go on to cause an infection, antibiotics will then not work when the patient really does need them.”

Dr Maureen Baker, chair of the Royal College of General Practitioners said: “We have developed a worrying reliance on [antibiotics] and GPs face enormous pressure to prescribe them, even for minor symptoms which will get better on their own or can be treated effectively with other forms of medication. 

“Our patients and the public need to be aware of the risks associated with inappropriate use of antibiotics and how to use them responsibly.” 

The research, carried out by scientists from Public Health England and University College London was published in the Journal of Antimicrobial Chemotherapy.