Urgent action needed to help GPs prescribe fewer antibiotics: study

A Queensland academic has called for monitoring of antibiotic resistance rates in the community, new targets and help for GPs to reduce how much of the drug they prescribe.

About 1600 people die directly from antibiotic resistance in Australia every year, according to a piece published in the latest Medical Journal of Australia.

The authors, led by Bond University academic Professor Chris Del Mar, said the situation would get steadily worse until 2050, when deaths from currently treatable infections would overtake total cancer deaths.

The antibiotic resistance crisis would also pose serious problems for now routine high-technology medical care.

Without reliable antibiotics, procedures such as chemotherapy, bone marrow transplant, major surgery such as joint replacement and invasive diagnostic procedures, such as cardiac catheterisation, would become too dangerous to perform.

Many aspects of medical care would retreat into the pre-antibiotic era of the 1930s, the economic consequences of which would be catastrophic, the authors said.

General practitioners contribute to most of the antibiotic tonnage consumed by humans in Australia, most often for acute respiratory infections, they said.

They said the reasons GPs prescribed so many antibiotics included:

  • Safety: It was difficult to separate apparently innocuous ARIs from the early stages of very serious infections
  • The doctor-patient relationship: GPs valued this and worried that not prescribing antibiotics threatened their relationship
  • Time: GPs perceived it was quicker to finish a consultation for ARI with an antibiotic prescription
  • Misconceptions about the effectiveness of antibiotics: GPs over-inflated the benefits of medical treatments generally

GPs also felt pressure to prescribe because of their perception that many patients expected antibiotics more often than was realistic, believing the drugs reduced symptom duration more than they actually did.

The authors suggested surveillance and targets of the background level of antibiotic resistance in the community, the rates of antibiotic prescribing by GPs and people admitted to hospital with serious infections which might have been averted by earlier use of antibiotics.

They said electronic health records could be set to "no repeats" by default, access to certain antibiotics could be restricted and treating symptoms without antibiotics could be highlighted to doctors.

Testing patients for diseases could also remove uncertainty when diagnosing them, but it would likely increase the cost of GP consultations.

"Although almost all ARIs are safe to manage with expectant observations, every GP knows that in the next patient presenting with an ARI, the condition may be a precursor to or the early stages of a more sinister illness, such as meningococcal meningitis, community-acquired pneumonia, peritonsillar abscess, mastoiditis and even the non-suppurative complications of acute rheumatic fever, or acute glomerulonephritis," they wrote.

The authors said it was uncertain whether there would be political support for an increase in the cost of GP consultations, which may double with "near-patient testing", while at the same time, antibiotics remained inexpensive.

This story Urgent action needed to help GPs prescribe fewer antibiotics: study first appeared on The Sydney Morning Herald.