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Antibiotic scrip rates lower in CAM-trained practices

Complementary/alternative medicine might help reduce over-prescribing of antibiotics

Louise Prime

Wednesday, 21 March 2018

NHS GP surgeries in England that employ GPs additionally trained in integrative (IM) or complementary and alternative medicine (CAM) have lower antibiotic prescribing rates, according to new research led from the University of Bristol. The study authors said their findings* – published in BMJ Open – suggest that this might hold the key to reducing antibiotic over-prescribing.

The research team conducted a retrospective study on antibiotic prescription rates per STAR-PU (Specific Therapeutic group Age–sex weighting Related Prescribing Unit), using data from NHS Digital data for 2016. They analysed data from 7,274 NHS GP surgeries in England, looking at the association between IM GPs and antibiotic prescribing rates per STAR-PU with the number of antibiotic prescriptions (total, and for respiratory tract infection (RTI) and urinary tract infection (UTI) separately). IM GP surgeries were similar to conventional GP surgeries in terms of list sizes, demographics, deprivation scores and comorbidity prevalence.

They found that significantly fewer total antibiotics (relative risk, RR 0.78) and respiratory tract infection (RTI) antibiotics (RR 0.74) were prescribed at NHS IM GP surgeries compared with conventional NHS GP surgeries; but the number of antibiotics prescribed for urinary tract infection (UTI) were similar in both types of practice.

The authors noted that their study was limited by lack of data on number of consultations, individual GP characteristics, individual deprivation scores and continuum of care; the pool of practices with GPs trained in IM was small as almost all current UK general practice provision is in the private sector. They added that the differences that they found between practices might also have had other possible causes, such as those patients who consulted practices with GPs trained in IM being less keen on getting antibiotics and/or practices with GPs trained in IM having other avenues to offer to patients than antibiotics.

They concluded: “NHS England GP surgeries employing GPs additionally trained in IM/CAM have lower antibiotic prescribing rates… Future research should include the differences in consultation behaviour of patients self-selecting to consult an IM GP or conventional surgery, and its effect on antibiotic prescription.

“Additional treatment strategies for common primary care infections used by IM GPs should be explored to see if they could be used to assist in the fight against antimicrobial resistance.”


*van der Werf ET, Duncan LJ, von Flotow PV, et al. Do NHS GP surgeries employing GPs additionally trained in integrative or complementary medicine have lower antibiotic prescribing rates? Retrospective cross-sectional analysis of national primary care prescribing data in England in 2016. BMJ Open 2018; 8:e020488. doi:10.1136/bmjopen-2017-020488.

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