Overprescribing antibiotics for respiratory infections
A study of around five hundred Australian GPs has found that antibiotics for respiratory infections are being prescribed at rates well beyond that recommended by national guidelines. The researchers published their findings in the Medical Journal of Australia and say the study is the first to quantify the excess prescribing of antibiotics for acute respiratory infections (ARIs). The objective of the study was to compare the current rate of antibiotic prescribing in general practice with recommendations given in Therapeutic Guidelines, the most widely consulted therapeutic guidelines in Australia.
Over-use of antibiotics in Australia
The risks associated with the over-use of antibiotics is well-publicised but Australians continue to be among the highest users of antibiotics in the world. The recently published study found that an estimated 230 cases per full-time GP per year were treated with at least one antibiotic, and that antibiotics were prescribed in 85 percent of acute cases of bronchitis/bronchiolitis and 11 per cent of influenza cases. Antibiotics were prescribed more frequently than recommended for rhinosinusitis, acute otitis media, and acute pharyngitis/tonsillitis.
The conclusion was that antibiotics for ARIs are prescribed at a rate four to nine times as high as that recommend in Therapeutic Guidelines. If Australian GPs were to adhere to the therapeutic guidelines antibiotics would be prescribed for 650,000 to 1.36 million cases a year, a difference of roughly five million prescriptions. With each course of antibiotics containing typically containing five grams of antibiotic, use could be reduced by 25 tonnes a year.
Reasons given for the overprescribing prescription of antibiotics include that GPs may want to minimise the risk of patients being exposed to dangerous bacterial infections by starting treatment early, and also uncertainty around diagnosis because symptoms are often vague and tests are not only expensive but also have a level of inaccuracy. There is also frequently pressure from patients for a prescription, and time pressures to get the consultation finalised. Additionally, the consequences of antibiotic resistance is rarely seen by those working in general practice or in primary care as patients are usually treated in hospital.
The researchers, led by public health professor Christopher Del Mar of Bond University, believe education hasn’t worked and that it is time to set national targets for prescription of antibiotics in general practice and that Australian GPs need to be supported to adopt a reduction in prescribing.
The study entitled ‘Antibiotics for acute respiratory infections in general practice: comparison of prescribing rates with guideline recommendations’ is available via the Overprescribing antibiotics for respiratory infections. Therapeutic Guidelines: Antibiotic, version 15 is available from Therapeutic Guidelines Limited (TGL), an independent not-for-profit organisation which aims to promote the quality use of medicines.