Kings College London study: Study investigates whether it is safe for GPs to prescribe fewer antibiotics

6 Jul

JAMA published “Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011” led by Katherine Fleming-Dutra, MD, estimated portions of antibiotic use that may be inappropriate in adults and children in the United States. – See more at: http://www.ajmc.com/newsroom/understanding-inappropriate-prescribing-of-antibiotics#sthash.lYnWSCqB.dpuf  This study found  “During 2010-2011, there were 506 annual antibiotic prescriptions per every 1000 population, but only 353 were likely appropriate.” Further, the study found:

Findings
The researchers used 2 annual surveys in 2010 and 2011 to collect data about patients’ demographic characteristics and symptoms, physicians’ diagnoses, and medications ordered, including antibiotics. They found that out of the 184,032 visits, 12.6% of encounters were associated with antibiotic prescriptions. Furthermore, 30% of outpatient prescriptions were in fact unnecessary and inappropriate.

The authors recommend development of diagnostic tests that can distinguish viral infections from bacterial infections in order to improve outpatient antibiotic use.

They used the 2010-2011 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) to collect data on patient demographics. Per 1000 population, the diagnosis that was associated with the most antibiotic prescriptions was sinusitis (56 antibiotic prescriptions), followed by suppurative otitis media (47), and pharyngitis (43). Collectively, acute respiratory conditions per 1000 population led to 221 antibiotic prescriptions each year but only 111 of these were actually appropriate for these conditions.

In general, across all ages and conditions, per 1000 population, an estimated 506 antibiotic prescriptions were written annually. And out of these, only 353 antibiotic prescriptions were estimated to be appropriate.

Spillage of Unnecessary Antibiotic Prescriptions
National guidelines state that patients with bronchitis, bronchiolitis, viral upper respiratory tract infections, asthma and allergy, influenza, and viral pneumonia should not receive antibiotics. Antibiotics prescribed for these conditions are considered inappropriate. And yet the study highlighted staggering numbers of inappropriate antibiotic prescriptions.

In an accompanying editorial, Pranita D. Tamma, MD, MHS, and Sara E. Cosgrove, MD, MS, wrote that the estimates in the Fleming-Dutra’s study were likely conservative, but they serve as a good starting point to understanding prescribing practices in the ambulatory care setting.

“Now that baseline estimates about outpatient antibiotic prescribing have been determined, future work needs to focus on interventions targeting both clinicians and patients to help reach the national goal,” wrote Pranita D. Tamma, MD, MHS, and Sara E. Cosgrove, MD, MS, and an accompanying editorial. “It will be critical to continue to evaluate progress in improving antibiotic use in conjunction with widespread adoption of antibiotic stewardship activities in the outpatient setting.” – See more at: http://www.ajmc.com/newsroom/understanding-inappropriate-prescribing-of-antibiotics#sthash.lYnWSCqB.dpuf

The practice of over-prescribing antibiotics has serious consequences.

Science Daily reported in Study investigates whether it is safe for GPs to prescribe fewer antibiotics:

A new study has found that reducing antibiotic prescribing for respiratory tract infections — such as coughs, colds, sore throats and ear infections — is not linked to an increase in the most serious bacterial complications, such as bacterial meningitis. The study, published in the BMJ, investigated whether reducing antibiotic prescribing for people attending their GP with respiratory tract infections could have an effect on safety.

Most respiratory tract infections are caused by viruses and will improve without treatment. Antibiotic treatment has minimal effect on the duration and severity of symptoms in these conditions, but may be associated with side-effects.

The widespread inappropriate use of antibiotics is contributing to the development of strains of bacteria that are resistant to antibiotics.

This study, funded by the NIHR and led by researchers from King’s College London, analysed patient records from 610 UK general practices, with more than four million patients, over 10 years. General practices with lower rates of antibiotic prescribing for respiratory tract infections did not have higher rates of serious bacterial complications, including: meningitis, mastoiditis (infection of the mastoid bone behind the ear), empyema (infection of the lining of the lungs), brain abscess or Lemierre’s syndrome (an infection of the jugular vein in the neck).

The research found that practices that prescribed fewer antibiotics had slightly higher rates of pneumonia and peritonsillar abscess (also known as quinsy) — a rare complication of sore throats. Both of these conditions are treatable with antibiotics once identified.

The researchers estimated that if an average-sized GP practice with 7,000 patients reduced its antibiotic prescribing to people with respiratory tract infections by 10 per cent, there could be one extra case of pneumonia each year. They also estimated that this reduced prescribing could be linked to one extra case of peritonsillar abscess every 10 years.

The authors observe that reducing antibiotic use is likely to reduce the number of people experiencing side-effects. About 10 per cent of people who take antibiotics experience common side-effects such as rashes, diarrhea and vomiting, while rare side-effects include anaphylaxis….https://www.sciencedaily.com/releases/2016/07/160704223418.htm

Citation:

Study investigates whether it is safe for GPs to prescribe fewer antibiotics

Date:              July 4, 2016

Source:         King’s College London

Summary:

A new study has found that reducing antibiotic prescribing for respiratory tract infections — such as coughs, colds, sore throats and ear infections — is not linked to an increase in the most serious bacterial complications, such as bacterial meningitis. The study investigated whether reducing antibiotic prescribing for people attending their GP with respiratory tract infections could have an effect on safety.

Journal Reference:

  1. Martin C Gulliford, Michael V Moore, Paul Little, Alastair D Hay, Robin Fox, A Toby Prevost, Dorota Juszczyk, Judith Charlton, Mark Ashworth. Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records. BMJ, 2016; i3410 DOI: 10.1136/bmj.i3410

Here is the press release from Kings College London:

Study on safety of prescribing fewer antibiotics

A new study has found that reducing antibiotic prescribing for respiratory tract infections – such as coughs, colds, sore throats and ear infections – is not linked to an increase in the most serious bacterial complications, such as bacterial meningitis.

The study, published in the BMJ, investigated whether reducing antibiotic prescribing for people attending their GP with respiratory tract infections could have an effect on safety.

Most respiratory tract infections are caused by viruses and will improve without treatment. Antibiotic treatment has minimal effect on the duration and severity of symptoms in these conditions, but may be associated with side-effects.

The widespread inappropriate use of antibiotics is contributing to the development of strains of bacteria that are resistant to antibiotics.

This study, funded by the NIHR and led by researchers from King’s College London, analysed patient records from 610 UK general practices, with more than four million patients, over 10 years. General practices with lower rates of antibiotic prescribing for respiratory tract infections did not have higher rates of serious bacterial complications, including: meningitis, mastoiditis (infection of the mastoid bone behind the ear), empyema (infection of the lining of the lungs), brain abscess or Lemierre’s syndrome (an infection of the jugular vein in the neck).

The research found that practices that prescribed fewer antibiotics had slightly higher rates of pneumonia and peritonsillar abscess (also known as quinsy) – a rare complication of sore throats. Both of these conditions are treatable with antibiotics once identified.

The researchers estimated that if an average-sized GP practice with 7,000 patients reduced its antibiotic prescribing to people with respiratory tract infections by 10 per cent, there could be one extra case of pneumonia each year. They also estimated that this reduced prescribing could be linked to one extra case of peritonsillar abscess every 10 years.

The authors observe that reducing antibiotic use is likely to reduce the number of people experiencing side-effects. About 10 per cent of people who take antibiotics experience common side-effects such as rashes, diarrhoea and vomiting, while rare side-effects include anaphylaxis.

Professor Martin Gulliford, lead author from the Division of Health and Social Care Research at King’s College London, said: ‘Overuse of antibiotics now may result in increasing infections by resistant bacteria in the future. Current treatment recommendations are to avoid antibiotics for self-limiting respiratory infections. Our results suggest that, if antibiotics are not taken, this should carry no increased risk of more serious complications. General practices prescribing fewer antibiotics may have slightly higher rates of pneumonia and peritonsillar abscess but even a substantial reduction in antibiotic prescribing may be associated with only a small increase in the numbers of cases observed. Both these complications can be readily treated once identified.’

Dr Mark Ashworth, GP and author of the study from the King’s Division of Health and Social Care Research, said: ‘As a practicing GP, I see very few complications from patients who have upper respiratory tract infections and who decide to opt for a non-antibiotic approach to treating their infections. Patients are recognising that most upper respiratory infections are viral and virus infections do not respond to antibiotics. Our paper should reassure GPs and patients that rare bacterial complications of respiratory infections are indeed rare. Fortunately, if there are any signs of a complication, the GP can quickly step in and offer an appropriate antibiotic.’

The authors caution that the results represent averages across general practice populations; this study did not evaluate the outcome of prescribing decisions for individual patients.

Notes to editors:

For more information, please contact the King’s College London press office on 020 7848 3202, pr@kcl.ac.uk.

‘Safety of reduced antibiotic prescribing for self-limiting respiratory tract infections in primary care: Cohort study using electronic health records’ by Gulliford et al is published in the British Medical Journal on Tuesday 5 July 2016.  doi: 10.1136/bmj.i3410

The study was funded by the NIHR Health Technology Assessment programme. Study authors were supported by the NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London.

About the NIHR

The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. The NIHR is the research arm of the NHS. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (www.nihr.ac.uk).

In many cases antibiotic use may not be appropriate.

FamilyDoctor.org offers the following advice:

How do I know when I need antibiotics?

The answer depends on what is causing your infection. The following are some basic guidelines:

  • Colds and flu. Viruses cause these illnesses. They can’t be cured with antibiotics.
  • Cough or bronchitis. Viruses almost always cause these. However, if you have a problem with your lungs or an illness that lasts a long time, bacteria may actually be the cause. Your doctor may decide to try using an antibiotic.
  • Sore throat. Most sore throats are caused by viruses and don’t need antibiotics. However, strep throat is caused by bacteria. Your doctor can determine if you have strep throat and can prescribe an antibiotic.
  • Ear infections. There are several types of ear infections. Antibiotics are used for some (but not all) ear infections.
  • Sinus infections. Antibiotics are often used to treat sinus infections. However, a runny nose and yellow or green mucus do not necessarily mean you need an antibiotic.  Read more about treating sinusitis.

What else do I need to know?

If your doctor does prescribe an antibiotic for you, make sure you take all of the medicine, even if you feel better after a few days. This reduces the chance that there will be any bacteria left in your body that could potentially become resistant to antibiotics.

Never take antibiotics without a prescription. If, for whatever reason, you have antibiotics leftover from a time when you were previously sick, do not take them unless your doctor tells you it’s okay. The leftover antibiotics may not work on whatever is making you sick. If they do work, there probably will not be enough leftover medicine to completely kill all the bacteria in your body. Not only will you not get better, but this increases the chance that the bacteria will become resistant to antibiotics.

You can prevent catching infections in the first place by practicing good hygiene. Wash your hands with soap and water, especially after using the restroom, coming into contact with feces (for example, from a pet or from changing a baby’s diaper) and before eating.                                                                             http://familydoctor.org/familydoctor/en/drugs-procedures-devices/prescription-medicines/antibiotics-when-they-can-and-cant-help.html

Always consult a physician before taking antibiotics.

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