Study reveals threat to public health by overuse of antibiotics

Posted: 20/08/2014

A recent study reported in yesterday's Guardian (19 August 2014) concludes that GPs are frequently prescribing unnecessary antibiotics that will not improve the patient’s health. 

In the survey of over 1,000 British GPs almost half admitted that they prescribed antibiotics several times a week even when they knew the treatment was not clinically indicated and would do nothing to improve the patient's health.  A further three out of ten GPs prescribe antibiotics where a patient's diagnosis is uncertain and antibiotics may or may not help.

Clinical assessment and judgment are clearly not the only factors at play.  Of the GPs surveyed, 90% said they feel pressured by patients to write prescriptions for antibiotics even when the patient's condition does not warrant using the drugs.  GPs also have to make these decisions at a consultation based on the patient's reported symptoms and often without any diagnostic test to enable the GP to assess the nature of their condition more definitively.  While it may sometimes be appropriate and cost-effective to prescribe antibiotics in cases where there is uncertainty, the overuse of antibiotics poses an increasing risk to wider public health in the longer term. 

Recent news reports have highlighted that the effectiveness of the antibiotics that have been at the core of infection control for years is being eroded by overuse and there are increasing problems with bacterial resistance.  There is significant concern that these drugs will stop working.  In July, the Prime Minister warned of the potentially devastating effect of not having antibiotics to treat infections, describing the risk of sending healthcare "back to the dark ages".  Diseases that have been well managed for decades may increase with potentially disastrous consequences.

This study is a precursor to the Longitude Prize, a £10 million prize fund that opens later this year.  Its objective is to find and develop cheap and easy diagnostic tests that would enable GPs to assess whether antibiotics are needed in a particular patient. 

Commenting on the report, Andrew Clayton of Penningtons Manches' clinical negligence team, explained: "There is a clear need for patients to understand that antibiotics are not a solution for every ailment and that it is not in their interests to take antibiotics when there is no bacterial infection to treat. The other issue is an assumption of infection and subsequent treatment by antibiotics which then masks the real illness.  The report is premised on GPs knowing when antibiotics are and are not effective but the reality is that GPs are prescribing antibiotics far more than is warranted or appropriate to manage patient expectations and the demands on their time.

“The risks to public health over the long-term must be given greater weight.  It is to be hoped the objective of the Longitude Prize can be achieved quickly and effectively to assist GPs in their clinical decision-making.  While a diagnostic test may not stop patients pressurising the GP, the results will at least give GPs the evidence to back up their clinical decision and to be more robust in denying antibiotics to patients for whom they would be inappropriate."

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