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GPs in the United Kingdom are still prescribing antibiotics for a large proportion of patients who attend with sore throat, otitis media, upper respiratory tract infections, and sinusitis despite national guidance warning against this, according to a study published this week based on analysis of the world's largest primary care database (Journal of Antimicrobial Chemotherapy 2007;60(suppl 1):i43-7).
The study assessed antibiotic prescribing in primary care using the general practice research database of consultations and prescriptions (GPRD), which collects information on about three million patients from general practices throughout the UK.
Researchers looked for all consultations between 1998 and 2001 for conditions that might have resulted in a prescription for antibiotics. They identified prescriptions for antibacterial drugs issued by 60 GPs on the same day as a consultation that had identified a possible condition treatable with antibiotics. 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 10 most common causes for prescribing an antibiotic 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.
More than 80% of patients seen with lower respiratory tract infection, urinary tract infection, sinusitis, impetigo, or conjunctivitis were prescribed antibiotics, despite the fact that UK guidance recommends against their use for most of these conditions. The same was true for 64% of patients with sore throat and 44% of patients with upper respiratory tract infections. Amoxicillin and erythromycin were the most commonly prescribed antibacterials for respiratory tract infections and otitis media.
The authors acknowledged that not all consultations for minor infections were recorded in the data and that those resulting in a prescription were more likely to be recorded, leading to an overestimate of the proportion of patients receiving an antibiotic. In addition, some GPs may have used delayed prescribing, in which they issue a prescription but advise the patient not to use it unless they fail to improve. But they concluded, “There remains scope for further reductions in antibacterial prescribing.”
To investigate the effect of patients' awareness of antibiotic resistance on prescribing patterns, the Department of Health sponsored a survey of public attitudes to antibiotics. More than one third (38%) of the 7120 respondents said that they had been prescribed an antibiotic in the past year (Journal of Antimicrobial Chemotherapy 2007;60(suppl 1):i63-8).
People were generally aware of the link between overuse of antibiotics and increased resistance. Only 8% of respondents did not agree that if antibiotics are taken too often they are less likely to work in the future. But many people (43%) incorrectly believed that antibiotics were effective in viral conditions.
Greater knowledge about antibiotics and when they should be used was not associated with a lower likelihood of being prescribed an antibiotic in the past year. Awareness of how antibiotics should be used did not necessarily correspond with appropriate behaviour. For example, 18% of people who said they knew that a course of antibiotics should always be completed also remarked that they would keep leftover antibiotics to use on another occasion.
The study authors warned, “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.”