Researchers found no association between the use of antibiotics in primary care and hospital admission risk, and warned that better tools are needed to help GPs target antibiotic prescribing.
An analysis of 15.7 million GP patient records of common infections by the University of Manchester suggested there is scope to prescribe far fewer antibiotics to tackle resistance.
Writing in the Journal of the Royal Society of Medicine, the team said of the infection diagnoses they looked at, 66% were prescribed an antibiotic.
For lower and upper respiratory tract infection and urinary tract infection, the researchers used a risk prediction score of hospital admission to categorise them and assess the probability of them receiving an antibiotic.
The probability of being prescribed an antibiotic for lower respiratory tract or urinary tract infection was unrelated to hospital admission risk, they found.
For upper respiratory tract infection the analysis showed a weak relationship to hospital admission risk, they reported.
Patient characteristics such as age and the presence of other health problems were only weakly associated with the probability of being prescribed an antibiotic treatment.
Elderly patients in the sample were 31% less likely than the youngest patients to receive an antibiotic for upper respiratory infections, the analysis showed.
It suggests that younger patients who could be fit enough to recover without antibiotics are being prescribed them while many older people who may benefit are not receiving them, with the potential of complication and hospital admissions.
Patients with multiple chronic diseases were 7% less likely than people without major health problems, to receive an antibiotic for upper respiratory infections, the research also showed. During the Covid pandemic, the level of ‘risk-based’ antibiotic prescribing reduced, they added.
The team concluded that GPs need to take more consideration of prognosis and the risk of the infection worsening.
The study said: ‘Given the possibility of AMR developing in patients and side-effects with antibiotics, there is a need to better target antibiotics in primary care to patients with worse prognosis.’
The researchers also added that a Knowledge Support System (KSS) they developed, which provides personalised information to clinicians, is now being tested in the North-West of England.
Professor Tjeerd van Staa, professor of e-health research at the University of Manchester, said: ‘Given the threat of resistance, there is a need to better target antibiotics in primary care to patients with higher risks of infection-related complications such as sepsis.
‘But this study finds that antibiotics for common infections are commonly not prescribed according to complication risk and that suggests there is plenty of scope to do more on reducing antibiotic prescribing.’
Co-author Dr Ali Fahmi, a postdoctoral researcher in epidemiology and statistics, said: ‘Rather than imposing targets for reducing inappropriate prescribing, we argue that it is far more viable for clinicians to focus on improving risk-based antibiotic prescribing for infections that are less severe and typically self-limiting.
‘Prognosis and harm should explicitly be considered in treatment guidelines, alongside better personalised information for clinicians and patients to support shared decision making.’
RCGP honorary secretary Dr Michael Mulholland said: ‘GPs understand the dangers of infections becoming resistant to antibiotics, and over many years have taken steps to curb antibiotics prescribing where possible.
‘As such, whilst antibiotics are an effective treatment against bacterial infections, GPs will not take the decision to prescribe them lightly, and are trained to do so only if they think it is in the best interests of the health of their patient, taking into account their individual circumstances and clinical guidance.’
He added the RCGP had helped to develop the TARGET antibiotics toolkit to support responsible antibiotic use.
‘What would be helpful is better access to tests to determine whether an infection is bacterial, and therefore antibiotics are more likely to be appropriate,’ he added.
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Including some sort of tool to prevent hospital staff (including doctors, but not only doctors) from telling pateints that they need an antibiotic, but the hospital are not allowed to prescribe it, so go to your GP and demand an antibiotic.
Unbelievable tripe. Just this week I have seen an 11 yr old who had been to his local pharmacy 3 times in the last 3 months for tonsillitis for “acute sore throat” and been given Pen V. No clinical information recorded in each of these monthly consultations whatsoever, no temp, no appearance of tonsils. Zero. Month 4 Mother comes with said child who has a typical viral urti, apyrexial, no exudate, expecting more Pen V which was not prescribed. The following week, another child, identical presentations to pharmacy, no recorded information, only difference was he had “only” been seen twice and given Pen V, mother expecting more antibiotics.
After decades of criticism and pressure about antibiotic prescribing as GP, this is a national disgrace brought about by commercial interests, a desperate and complete inept NHSE and ivory tower academics.
Put your own houses in order.