A new study by scientists at Public Health England (PHE) and University College London (UCL) has found that the likelihood of general practitioners (GPs) prescribing antibiotics for coughs and colds increased by 40% between 1999 and 2011, despite Government recommendations to reduce prescribing for illnesses largely caused by viruses.
The researchers also found that there was substantial variation in prescribing between general practices, with the highest prescribing practices twice as likely to give a prescription for coughs and colds as the lowest prescribers.
This research is published in today’s Journal of Antimicrobial Chemotherapy.
Specific recommendations on better prescribing by GPs, first made by the Department of Health in 1998, and regularly updated by PHE and endorsed by the Royal College of General Practitioners include:
- no prescribing of antibiotics for simple coughs and colds
- no prescribing of antibiotics for viral sore throats
- limiting prescribing for uncomplicated cystitis to a 3 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.
RCGP Chair Dr Maureen Baker said:
Antibiotics are very effective drugs, as long as they are used appropriately.
But we have developed a worrying reliance on them 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.
This study reinforces the message that we issued recently for frontline health professionals to resist pressure from patients for unnecessary prescriptions and explore alternatives to them.
The researchers monitored trends in prescribing at 537 GP practices to assess whether treatment guidelines were being followed.
The findings were as follows:
Coughs and colds
The proportion of patients who were prescribed an antibiotic by their GP for coughs and colds decreased from 47% in 1995 to 36% in 1999 but rose again to 51% by 2011. Strikingly, the researchers found marked variation between GP practices with some prescribing at twice the level of the lowest prescribing practices. The 10% of practices with the lowest prescribing rates prescribed antibiotics in less than a third of patients with cough and cold whereas the 10% of GP practices with the highest prescribing rates prescribed antibiotics to about 2-thirds of such patients.
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.
Urinary tract infection (UTI)
Use of the recommended short course trimethoprim (the preferred antibiotic) in women aged 16 to 74 increased from 8% in 1995 to 50% in 2011. However, the between practice variation in prescribing of the recommended short course was very marked for this condition ranging from 16% or less to more than 70%.
Prescribing for this infection 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.
Notes to Editors
- Read the current edition of the Journal of Antimicrobial Chemotherapy
- The researchers from UCL were from the Farr Institute of Health Informatics Research.
- The UK Department of Health’s Standing Medical Advisory Committee (SMAC) Sub-Group on Antimicrobial Resistance report in 1998 recommended to GPs ‘4 things you can do to make a difference’ and these are available from the antibiotic action website. These SMAC recommendations were supplemented by more detailed professional guidance by the UK Health Protection Agency (HPA, now Public Health England) and endorsed by the Royal College of General Practitioners on which antibiotics to prescribe in primary care and when they are indicated.
- coughs and colds - no prescribing of antibiotics for simple coughs and colds
- sore throats - the guidance recommends that antibiotics should generally be avoided, unless sufficient clinical criteria that might indicate a more serious infection are met, when specific antibiotics may be used
- bladder infection (cystitis) - the guidance recommends that uncomplicated cystitis in otherwise fit women aged 16 to 64 years old, short courses (3 days) of antibiotics can be prescribed, rather than a 7 day course
- otitis media - the guidance recommends specific antibiotics can be prescribed if there are signs of severe infection
- limit prescribing of antibiotic agents over the telephone to exceptional cases
- The primary care database used in the study was The Health Improvement Network which covers 3.8 million active patients.
- Reducing inappropriate prescribing of antibiotics is a key component of the 5-year strategic plan for tackling the problem of antibiotic resistance recently published by the UK government.
- Practices were measured in the 10th to 90th percentile range.
- The Journal of Antimicrobial Chemotherapy is among the foremost international journals in antimicrobial research. Our readership includes representatives of academia, industry and health services, and includes those who are influential in formulary decisions. It is published by Oxford University Press on behalf of The British Society for Antimicrobial Chemotherapy.
PHE exists to protect and improve the nation’s health and wellbeing and reduce health inequalities. It does this through advocacy, partnerships, world-class science, knowledge and intelligence, and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health.
www.gov.uk/phe Follow us on Twitter @PHE_uk