The Burden of Antibiotic Prescribing

So why does GP antibiotic prescribing matter? If we think about what’s happening now, we– on average– prescribe for more than half of people seeing us with acute respiratory infection. You can see cough and bronchitis around half. 60% of people presenting with sore throat. And around 60% with otitis media. And GPs account for around 80% of all the antibiotics prescribed for humans in the UK. So it is a problem for primary care to think about.

If we think about resistance in primary care, we’re not particularly aware of it at the moment– obviously, you’ll get reports back periodically where there are resistant organisms– but resistance levels are generally increasing. This is a meta analysis which has looked to at individual level resistance following antibiotic treatment. And individuals have at least a doubling of the risk of carrying a resistant bug two months after an antibiotic course. And that persists for around about 12 months. So at an individual level, people who have antibiotics are going to be more likely to be carrying resistant organisms. Finally, if we just think about prescribing and consultation rate– is there a link between those two?

There’s a 10-fold variation in the consultation rate for respiratory tract infection between practises. And a big variation in the proportion of those who will receive an antibiotic prescription. If you look carefully at this, you’ll see that high prescribing practises are the ones with high consultation rates and practises which reduce– their prescribing rates experience a reduction in consultation rates following this. So it looks as if what we do in our surgeries is influencing the people who come and see us in the future. And that by changing our behaviour, it may well change consultation patterns in the future. So just before I move on, just to summarise where we’ve got to– antibiotic resistance is important.

GP prescribing is an important part of that. GPs currently prescribed most of the time when people consult with a respiratory infection. And higher prescribing is both linked to resistance and higher consultation rates in the future.