UK doctors are filling out 10m unnecessary prescriptions for antibiotics every year, contributing to the rising threat of resistance to critical antimicrobial drugs, according to NICE.
The UK cost-effectiveness agency suggests that in order to curb the problem prescribers could face disciplinary action if they give in to patients demanding antibiotics, with reporting to the General Medical Council (GMC) used as a “last resort” for persistent offenders.
NICE cites research which suggests nine out of 10 GPs feel pressured to prescribe antibiotics – even for inappropriate indications such as viral infections – because the public has grown accustomed to receiving them even. Meanwhile, 97% of patients who ask for antibiotics are prescribed them, it adds.
Nationally, 41.6 million antibacterial prescriptions were issue in 2013/14, costing the NHS around £192m, says NICE, which issue a draft version of the guidance in earlier this year. If implemented fully the new guidelines would cut antibiotic prescribing by around 25%.
The new guidelines encourage the creation of information systems at the commissioner level to provide information on antimicrobial prescribing recommendations and resistance rate. They should also monitor rates and trends of prescribing within their own organisations and communicate this information back to doctors.
It also recommends setting targets to prescribers to adhere to best practices when prescribing antibiotics and “working with prescribers to understand the reasons for very high, increasing or very low volumes of antimicrobial prescribing.”
The new document builds on guidance issued towards the end of last year – specifically looking at prescribing in pneumonia cases – which called for greater use of diagnostics to tell whether a patient was presenting with a bacterial or viral infection. In 2007, NICE also issued advice on upper respiratory tract infections that also sought to curb inappropriate antimicrobial prescribing.
“I don’t think there is a lot of bad practice in general practice but it is clear that the reduction in antibiotic prescribing that we expected to see when our 2007 guideline … was published has not happened,” said Prof Mark Baker, director of the Centre for Clinical Practice at NICE.
Rather than relying on punitive measures, however, Baker insisted that “what we want to see is doctors and other health professionals getting the necessary support to help them prescribe the right antibiotic at the right dose at the right time.”
The O’Neill report published towards the end of last year predicted that resistance to antibiotic medicines could account for 10 million extra deaths a year by 2050 if action is not taken.