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GPs should question colleagues on antibiotic prescribing – NICE

Doctors should question colleagues who they believe prescribe too many antibiotics, the National Institute for Health and Care Excellence (NICE) has recommended.

The health watchdog has issued draft guidance to clamp down on prescribing such medication, in an attempt to avert the “growing threat” of antimicrobial resistance.

Annual National Antibiotic Charts, from NHS Prescription Services, show that antibiotic prescribing across England has been steadily increasing for years.

A new infectious disease has been discovered nearly every year for the past 30, but very few new antibiotics have been developed – meaning existing antibiotics are used to treat an ever-greater variety of infections and infectious diseases.

Professor Mark Baker, director of the Centre for Clinical Practice at NICE, said: “This draft guidance recognises that we need to encourage an open and transparent culture that allows health professionals to question antimicrobial prescribing practices of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.”

NICE added that nationally 41.6 million antibacterial prescriptions were issued in 2013-14 at a cost to the NHS of £192m. Despite considerable guidance that prescribing rates of antibiotics should be reduced, nine out of 10 GPs feel pressured to prescribe antibiotics, and 97% of patients who ask for antibiotics are prescribed them.

“The more we use antibiotics, the less effective they become as diseases evolve and become resistant to existing antimicrobial medicines,” said Professor Alastair Hay, professor of Primary Care and chair of the committee that developed the guideline.

“Resistance to all antimicrobials is increasing and, combined with a lack of new antimicrobial medicines, there is a heightened risk in the future that we may not be able to treat infections effectively. “

As well as highlighting the need for local antimicrobial stewardship programmes, the draft guideline also recommends setting up multidisciplinary antimicrobial stewardship teams working across all care settings. These teams would be able to review prescribing and resistance data frequently and feed this information back to prescribers.

Professor Dame Sally Davies, chief medical officer for England, added that preserving the effectiveness of antibiotics is “absolutely crucial”. She also encourages prescribers to engage with the consultation to give their views on how current practice can be improved.

Speaking on behalf of prescribers, the chair of the Royal College of GPs, Dr Maureen Baker, said that “antibiotics have served us well in treating infections for over 60 years”, but as a society “we have become too dependent on them” and they are now seen as a ‘catch all’ for every illness and infection.

She added: “GPs can come under enormous pressure from patients to prescribe antibiotics so we welcome a team approach to ensuring that this is done appropriately and that they are used responsibly.”

Dr Baker said that it is “essential” that GPs, their practice teams and pharmacists discuss the alternatives with patients who ask for antibiotics to treat minor illnesses, most of which will get better on their own over time.

The draft guideline on antimicrobial stewardship is the first NICE guidance to deal exclusively with the issue of antimicrobial use and the growing problem of antimicrobial resistance. It is anticipated that the guidance’s publication date will be in July 2015.

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