Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

GPs antibiotic prescribing practices are still contributing to resistance

26.07.2007
GPs are still prescribing antibiotics for up to 80% of cases of sore throat, otitis media, upper respiratory tract infections, and sinusitis, despite the fact that official guidance warns against this practice, according to an analysis1 of the world’s largest primary care database of consultations and prescriptions, published this week in a supplement2 to the Journal of Antimicrobial Chemotherapy.

Although prescriptions of antibiotics for respiratory tract infections declined during the 1990s, GPs still continue to prescribe antibiotics for a high proportion of infections even if the cause of the symptoms are likely to be viral. And this practice is hindering efforts to prevent the spread of antibiotic resistance - whereby disease-causing bacteria become unresponsive to the most commonly used drug treatments.

“Many doctors believe that by giving an antibiotic they might be doing some good or at least covering the possibility of a missed diagnosis of significant bacterial disease, with little thought given to the possibility of doing harm,” explains Douglas Fleming, a GP and member of the UK’s Specialist Advisory Committee on Antimicrobial Resistance, a government advisory body, in an accompanying perspective article.3

The study attempted to assess antibiotic prescribing in primary care by use of the General Practice Research Database of consultations and prescriptions. The researchers searched for all consultations between 1998 and 2001 for conditions that might have resulted in an antibiotic prescription. They then identified prescriptions for antibacterial drugs issued by 60 GPs on the same day as a consultation that had identified a possible antibiotic-treatable condition. If an antibacterial was prescribed on the same day as a possible antibiotic indication, it was assumed that the drug had been prescribed for that purpose.

The ten most common causes of antibacterial prescribing identified in the study were: upper respiratory tract infection, lower respiratory tract infection, sore throat, urinary tract infection, otitis media, conjunctivitis, vague skin infections without a clear diagnosis, sinusitis, otitis externa, and impetigo. The researchers found that for some of these conditions over 80% of cases were being treated with antibiotics, despite the fact that guidance recommend against antibiotics for sore throat, otitis media, upper respiratory tract infections, and sinusitis.

Regular analysis of the data should be done to monitor trends in GP prescribing, which are known to have plateaued since 2001, suggest the authors. According to a review4 of professional attitudes to antibiotic prescribing, published as part of the supplement by the professional education subgroup of the Specialist Advisory Committee on Antimicrobial Resistance, GPs and other prescribers must be educated about how to dispense treatment appropriately and avoid adding to the problem of resistance.

“We must not be lulled into a false sense of security believing the prescribing behaviour of GPs has changed. It is preferable to focus interventions on changing behaviour rather than trying to persuade doctors from evidence of the link between resistance and inappropriate prescribing,” comments Dr Fleming.

One of the most important determinants of whether or not a patient receives a prescription for antibiotics is if they have had previous prescriptions for that condition. Clinicians report that they often prescribe antibiotics because they perceive that patients want them. To investigate the effect of patient awareness of antibiotic resistance on prescribing patterns, a multicentre team sponsored by the Department of Health surveyed public attitudes to antibiotics in a separate study5 published in the same supplement.

38% of the 7120 respondents reported that they had been prescribed an antibiotic in the last year. However, the survey found a surprisingly high proportion of people believe that antibiotics work on viral conditions and found that a greater knowledge about antibiotics and when they should be used was not associated with a lower likelihood of being prescribed an antibiotic in the last year. The study also found that awareness of how antibiotics should be used did not necessarily correspond with appropriate behaviour. For example, individuals who said they knew that a course of antibiotics should always be completed also remarked that they would keep left over antibiotics to use on another occasion.

“Although a third of the public still believe that antibiotics work against coughs and colds, simply getting the public to believe otherwise may not be enough to reduce the level of prescribing. We have shown that those with greater knowledge about antibiotics are no less likely to be prescribed an antibiotic,” comment the report’s authors.

How to communicate messages about the risk of drug resistance will become more pressing in future because resistance to antiviral drugs - as well as antibacterials - is a growing concern, according to Dr Deenan Pillay, who authored an essay about priorities for antiviral drug surveillance in the supplement.6

“The emergence of antiviral drug resistance is virtually inevitable. This provides a major clinical, laboratory, and public health challenge. We have already learnt the potential for spread of these viruses from experience with HIV. A coordinated approach is required to ensure that the clinical benefit afforded by these drugs is maintained,” he warns.

All the essays for the supplement relate to the work of the Specialist Advisory Committee on Antimicrobial Resistance (SACAR), a body that was set up in 2001, under the Chairmanship of Professor Richard Wise, to advise ministers and the Chief Medical Officer on current and emerging problems in antimicrobial resistance. The committee was charged with helping to minimise emerging antimicrobial resistance and its possible impact, while ensuring that measures are in place in a timely manner to meet threats to clinical management. The SACAR is now standing down to make way for a new body, the Advisory Committee on Antimicrobial Resistance and Associated Health Care Infections, to be headed by Professor Roger Finch.

Professor Richard Wise | alfa
Further information:
http://www.oxfordjournals.org/our_journals/jac/press_releases/freepdf/supplement_july07.pdf

More articles from Health and Medicine:

nachricht NTU scientists build new ultrasound device using 3-D printing technology
07.12.2016 | Nanyang Technological University

nachricht How to turn white fat brown
07.12.2016 | University of Pennsylvania School of Medicine

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Significantly more productivity in USP lasers

In recent years, lasers with ultrashort pulses (USP) down to the femtosecond range have become established on an industrial scale. They could advance some applications with the much-lauded “cold ablation” – if that meant they would then achieve more throughput. A new generation of process engineering that will address this issue in particular will be discussed at the “4th UKP Workshop – Ultrafast Laser Technology” in April 2017.

Even back in the 1990s, scientists were comparing materials processing with nanosecond, picosecond and femtosesecond pulses. The result was surprising:...

Im Focus: Shape matters when light meets atom

Mapping the interaction of a single atom with a single photon may inform design of quantum devices

Have you ever wondered how you see the world? Vision is about photons of light, which are packets of energy, interacting with the atoms or molecules in what...

Im Focus: Novel silicon etching technique crafts 3-D gradient refractive index micro-optics

A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.

Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...

Im Focus: Quantum Particles Form Droplets

In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.

“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...

Im Focus: MADMAX: Max Planck Institute for Physics takes up axion research

The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.

The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ICTM Conference 2017: Production technology for turbomachine manufacturing of the future

16.11.2016 | Event News

Innovation Day Laser Technology – Laser Additive Manufacturing

01.11.2016 | Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

 
Latest News

NTU scientists build new ultrasound device using 3-D printing technology

07.12.2016 | Health and Medicine

The balancing act: An enzyme that links endocytosis to membrane recycling

07.12.2016 | Life Sciences

How to turn white fat brown

07.12.2016 | Health and Medicine

VideoLinks
B2B-VideoLinks
More VideoLinks >>>