GPs advised against antibiotic overuse

Patients should be prescribed the correct dose at the right time to reduce and avoid antibiotic-resistant infections, according to new guidelines issued by the National Institute for Health and Care Excellence (NICE).

Overusing antibiotics could lead to bugs becoming resistant, making many current infections and diseases untreatable.

The NICE has published guidelines for doctors, nurses and pharmacists, encouraging them to practice and monitor sensible use of antimicrobials – the group of medicines commonly used to kill and prevent the growth of microorganisms, including antibiotics, antivirals, antiparasitics and antifungals.

GP and medical advisor to All Wales Therapeutics and Toxicology Centre and vice chair of the Guideline Development Group, Dr Tessa Lewis, said: “The more we use antibiotics, the less effective they become. Infections can evolve and become resistant to existing medicines. Resistance to antibiotics is increasing and there have been very few new antibiotics developed in recent years, so we need to make sure that, as well as searching for new antimicrobial medicines we use the ones we currently have in the most effective way.

"This NICE guideline considers the whole area of antimicrobial prescribing. It looks at the evidence and makes recommendations for health and social care practitioners and organisations on the best ways to minimise antimicrobial resistance.”

GPs feel under pressure to prescribe patients antibiotics

Antibiotics have been used for treating infections for more than 60 years and although a new infectious disease has been discovered almost every year for the past 30 years, few new antibiotics have been developed. The current range of antibiotics being used to treat a wider variety of infections and infectious diseases.

Director of the Centre for Clinical Practice at NICE, Professor Mark Baker, commented: “We need to encourage an open and transparent culture that allows health professionals to question antimicrobial prescribing practices of colleagues when these are not in line with local and national guidelines and no reason is documented.

“It’s not just prescribers who should be questioned about their attitudes and beliefs about antibiotics. It’s often patients themselves who, because they don’t understand that their condition will clear up by itself, or that perhaps antimicrobials aren’t effective in treating it, may put pressure on their doctor to prescribe an antibiotic when it is not indicated and they are unlikely to benefit from it.”

The prescribing of antibiotics has increased steadily in England over several years, while during 2013–14, 41.6 million antibiotics were dispensed, costing the NHS £192 million.

GPs have reported to feeling under pressure to prescribe patients antibiotics with figures suggesting 97 per cent of patients who ask are prescribed them. Whilst 90 per cent of GPs admitted feeling pressured to prescribe, despite there already being guidelines available to reduce the amount of prescriptions.

'Resistance to antibiotics is increasing and very few new antibiotics have been developed in recent years'

Professor Baker continued: “Research has shown that misconceptions about antimicrobial resistance are widespread. Many people think that it is their body which becomes resistant, rather than the bacteria that cause antimicrobial-resistant infections. This often makes it feel that the issue of resistance is someone else’s problem.

“The guideline therefore recommends that prescribers take time to discuss with patients the likely nature of their condition, the benefits and harms of immediate antimicrobial prescribing, alternative options such as watchful waiting and/or delayed prescribing and why prescribing an antimicrobial may not be the best option for them – for example, if they have a self-limiting respiratory tract infection. The guideline also recommends that patients are given advice about who they should contact if they have concerns about infection after discharge from hospital.”

In addition to stressing the importance of antimicrobial stewardship programmes, the NICE guidelines suggest establishing multidisciplinary antimicrobial stewardship teams to work within all care environments.

It is hoped the teams will be able to review the prescribing on antibiotics and data associated with the frequency of resistance, to feed the information back to prescribers.

Furthermore the teams will work with prescribers to establish the reasons behind high and low levels of antimicrobial prescribing and provide feedback to those prescribed outside guidelines where it is considered unnecessary.

Pharmacist lead for the Antimicrobial Resistance Programme at Public Health England, Dr Diane Ashiru-Oredope, said: “Public Health England (PHE) welcomes this new guidance from NICE on antimicrobial stewardship for commissioners and providers.

“Antimicrobial stewardship programmes which aim to reduce inappropriate prescribing and optimise antibiotic use are a crucial part of work to combat antimicrobial resistance (AMR), and antimicrobial stewardship is an important element of the UK Five Year Antimicrobial Resistance Strategy.

“Tackling AMR is one of PHE’s national priorities and today, in partnership with NHS England and Health Education England, we have issued a patient safety alert on antimicrobial stewardship, which highlights the key tools that can help organisations fulfil many aspects of this new guidance from NICE.”

The new guidelines are the first to be published by NICE that solely focus on the prescription and use of antimicrobials and antibiotic resistance. The NICE is working on producing a set of public health guidelines to focus on changing the knowledge and attitudes associated with the use of antimicrobials.