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Rein in antibiotic prescriptions, GPs urged

Healthcare professionals too eager to give in to misinformed patients, says HPA

Caroline White

Friday, 18 November 2011

GPs must learn to resist the demands of patients wanting antibiotics for coughs and colds, in a bid to help curb the rise of resistance to these vital drugs, the Health Protection Agency (HPA) has warned today, European Antibiotic Awareness Day.

The warning was prompted by the results of survey commissioned by the agency of over 1700 people in England who were quizzed in January this year about their attitudes to antibiotics.

Over half of those who contacted a doctor or nurse (53%) went expecting antibiotic treatment and one in four respondents believed that antibiotics work on most coughs and colds.

Yet seven out of 10 respondents recognised that antibiotic resistance is a problem in British hospitals and a similar number acknowledged that resistance to antibiotics could affect them and their family.

“Although the public recognises resistance as a problem, our findings show that people expect, and are often prescribed, antibiotics for mild illnesses such as coughs, colds and sore throats as well as for flu, which can be more severe, but is still a viral illness,” said Dr Cliodna McNulty, HPA head of primary care and lead on European Antibiotic Awareness Day.  

“Health professionals need to learn to resist demands from patients for treatments they know have little or no effect on coughs and colds. Our research showed that 97% of those questioned said that the last time they asked their GP or nurse for an antibiotic they were prescribed one.”

The HPA’s comments are echoed by the Department of Health, which has published new guidance Start Smart, Then Focus for hospital prescribers to help them use these drugs appropriately.

“It is important we use antibiotics in the right way if we are to get the best outcome for the patient, slow down resistance and make sure these important medicines continue to stay effective for ourselves and for future generations,” commented chief medical officer, professor Sally Davies.

Professor Laura Piddock, President of the British Society for Antimicrobial Chemotherapy (BSAC), claims in The Lancet Infectious Diseases that the dearth of new antibiotics, combined with increasing resistance, is pushing the world towards the unthinkable scenario of untreatable infections.

“Antibiotics are not perceived as essential to health or the practice of medicine, despite such agents saving lives so that individuals can live for many years after infection,” she says.

The problem is particularly acute for treatment of Gram-negative bacterial infections such as those caused by Acinetobacter baumanii, Pseudomonas aeruginos, and multi-drug resistant Escherichia coli.

Two years ago, WHO announced antibiotic resistance as one of the three biggest threats to health. Yet little action has been taken so far. Yesterday, the EU launched the Commission's 5-year Action Plan on Antimicrobial Resistance (AMR). But there remains as yet no globally joined up movement to push antibiotics to the top of health agendas.

Just as the GAVI Alliance and the Bill and Melinda Gates Foundation have successfully delivered vital vaccines worldwide, a similar model could be used to encourage new antimicrobial development, suggests Professor Piddock.

“Until a global alliance for antibiotic drug discovery and development is formed, pharmaceutical companies need to recognise that many expensive medicines in their portfolio and in development might by useless if patients succumb to fatal infections,” she says.

“Therefore, their return on investment for products to treat cancer or chronic diseases depends, in part, on effective treatment of infections. This fact alone should be an incentive for pharmaceutical companies to continue or re-enter antibiotic development.”

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