Doctors’ antibiotic prescriptions should be scrutinised, says NICEBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h967 (Published 19 February 2015) Cite this as: BMJ 2015;350:h967
Doctors should have their antibiotic prescribing scrutinised and told whether it is higher than average for their area or falls outside of recommended uses, draft guidelines have said. Prescribers also need to stand up to patients who demand antibiotics when they are not appropriate, the guidelines say.
The recommendations are part of the guidance on antimicrobial stewardship from the National Institute for Health and Care Excellence (NICE), which is open for consultation until 17 March.1 They will apply to anyone who prescribes antimicrobial medicines, although most antibiotic prescribing (79%) takes place in general practice.
The draft guidance recommends setting up multidisciplinary antimicrobial stewardship teams that work across all care settings. These teams should monitor GPs’ prescribing, feed back to them how their use of antimicrobials compares with local averages, and help them to adjust their practices if these fall outside of local norms, it advises.
Figures from Public Health England published last October showed that GPs’ prescribing of antibiotics in England rose by 4% from 2010 to 2013, while hospitals’ prescribing rose by 12%, despite efforts to curb it.2 And in March 2013 England’s chief medical officer, Sally Davies, warned that antimicrobial resistance was a “ticking time bomb” that posed an “apocalyptic” threat similar to that of climate change, where deaths from infections could again become as common as they were in the early 19th century.3
The Department of Health responded by setting out a five year plan to tackle the growing threat of antimicrobial resistance that outlined national plans for better education, treatment, and monitoring of bacteria, as well as more international cooperation.4 The latest guidance from NICE was commissioned by the government.
Mark Baker, director of the Centre for Clinical Practice at NICE, said, “This draft guidance recognises that we need to encourage an open and transparent culture that allows health professionals to question antimicrobial prescribing practices of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 [where] no reason is documented.”
However, he acknowledged that pressure to prescribe antibiotics often came from patients. He said that surveys had shown that nine in 10 GPs felt pressured to prescribe antibiotics and that 97% of patients who asked for antibiotics were prescribed them.
Baker added, “The draft guideline therefore recommends that prescribers take time to discuss with patients the likely nature of their condition, the benefits and harms of immediate antimicrobial prescribing, alternative options such as watchful waiting and/or delayed prescribing and why prescribing an antimicrobial may not be the best option for them—for example, if they have a self limiting respiratory tract infection.”
Commenting on the guidance Maureen Baker, chair of the Royal College of General Practitioners, said, “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.
“We need to do everything we can to prevent patients and the public building up a resistance, so that antibiotics remain effective in the future when they might really need them. We also desperately need research and investment to develop new antibiotics to tackle emerging diseases.”
The finalised guidance on antimicrobial stewardship is expected to be published in July.
Cite this as: BMJ 2015;350:h967