“GPs face axe for handing out too many pills,” the Daily Mail reports. The headline is prompted by remarks made by Professor Mark Baker, clinical practice chief at the National Institute for Health and Care Excellence (NICE) which has published new guidelines on antibiotic prescribing.
The guidelines are an attempt to tackle the growing problem of antibiotic resistance.
Increasingly widespread use of antibiotics is leading to the organisms causing these infections adapting and surviving. As this resistance develops, it can render treatments for infections less effective and eventually the infections may become untreatable.
What is antibiotic resistance and how does it develop?
Bacteria evolve in response to their environment. Over time, they can develop mechanisms to survive a course of antibiotic treatment.
This “resistance” to treatment starts as a random mutation in the bacteria’s genetic code, or the transfer of small pieces of DNA between bacteria. If the mutations are favourable to them, they are more likely to survive treatment, more likely to be able to replicate and therefore more likely pass on their resistant nature to future generations of bacteria.
When taken correctly, antibiotics will kill most non-resistant bacteria, so these resistant strains can become the dominant strain of a bacteria. This means when people become infected, existing treatments may be unable to stop the infections.
Widespread antibiotic resistance could have a far-reaching healthcare impact. For example, emerging antibiotic resistance increases the chance that surgical sites could be infected by bacteria resistant to antibiotics and cause infection in people who may already be vulnerable as a result of their underlying illness or from having surgery.
What recommendations do the guidelines make?
- Individual health organisations should set up multidisciplinary antimicrobial stewardship teams – a group of health professionals, including a pharmacist and microbiologist, who review the use of antibiotics by that organisation. If patterns of antibiotic prescribing are unusually high, or there is evidence that antibiotics are not being used in line with current guidelines, they would be responsible for exploring why.
- When prescribing antibiotics, prescribers should provide the shortest effective dose.
- Prescribers should discuss alternative options to antibiotics with their patients, and if appropriate, explain why prescribing antibiotics may not be the best option.
- Antibiotics should not be immediately prescribed to patients with a condition that is likely to get better by itself (self-limiting condition). Prescribers should consider whether a back-up prescription could be a more appropriate choice – this is where a patient could get access to antibiotics if their condition does not get better after a set number of days.
- The use of repeat prescriptions for antibiotics should be avoided, unless there is a clear clinical need. Patients who do require repeat prescriptions should be carefully monitored and reviewed on a regular basis.
Are doctors really going to be ‘struck off’ for over-prescribing?
Many of the newspapers seized on remarks by Professor Baker, who is quoted as saying, “Most doctors prescribe sensibly and competently. For the relatively small number who are less-disciplined, first we need to identify them, and secondly there need to be processes to deal with them.
“Ultimately, if they fail to come into line there is always recourse to the professional regulator and there are a number of performance processes that the GMC [General Medical Council] can set to improve the clinical performance of practitioners.”
It is likely that doctors would only be referred to the GMC in the most extreme cases.
The guidelines are designed to support and educate health professionals in the appropriate use of antibiotics. It is not a charter for sacking GPs.
How can you help?
Antibiotic resistance is not somebody else’s problem. It is everybody’s problem.
You can help by not requesting them for minor self-limiting conditions – especially coughs and colds, which are likely to be caused by a virus, meaning antibiotics would be of no benefit.
If your doctor does prescribe antibiotics for you, make sure that you’ve discussed and understood how to take them correctly, and that you take all the prescribed pills, regardless of whether you still have symptoms. If you do not take the full prescribed dose, chances are that some of the bacteria will not be killed, and these are more likely to be resistant strains.
Read more about what you can do to tackle the problem of antibiotic resistance