NICE tackles overuse of antibiotics

UK health watchdog, the National Institute for Health and Care Excellence (NICE), has published guidance to help doctors, nurses and pharmacists promote and monitor the sensible use of antimicrobials.

Antibiotics have been the mainstay of treating infections for over 60 years. Although a new infectious disease has been discovered nearly every year over the past 30 years, very few new antibiotics have been developed. This means existing antibiotics are used to treat an ever greater variety of infections and infectious diseases.

96% of patients who ask for antibiotics are prescribed them

Overall antibiotic prescribing in England has been steadily increasing over several years. Nationally, 41.6 million antibiotic prescriptions were issued in 2013 -14 at a cost to the NHS of £192 million. Despite considerable guidance that prescribing rates of antibiotics should be reduced, 9 out of 10 GPs say they feel pressured to prescribe antibiotics, and 97% of patients who ask for antibiotics are prescribed them.

“The more we use antibiotics, the less effective they become. Infections can evolve and become resistant to existing medicines” said Dr Tessa Lewis, GP and Medical Advisor to All Wales Therapeutics and Toxicology Centre and Vice Chair of the Guideline Development Group. “Resistance to antibiotics is increasing and there have been very few new antibiotics developed in recent years, so we need to make sure that, as well as searching for new antimicrobial medicines we use the ones we currently have in the most effective way.

“This NICE guideline considers the whole area of antimicrobial prescribing. It looks at the evidence and makes recommendations for health and social care practitioners and organisations on the best ways to minimise antimicrobial resistance.”

As well as highlighting the need for local antimicrobial stewardship programmes, the guideline also recommends setting up multidisciplinary antimicrobial stewardship teams working across all care settings. These teams should be able to review prescribing and resistance data frequently and feed this information back to prescribers. They should also be able to work with prescribers to understand the reasons for very high, increasing or very low volumes of antimicrobial prescribing as well as provide feedback and assistance to those who prescribe antimicrobials outside of local guidelines where this is not justified.

Misconceptions about antimicrobial resistance is widespread

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said, “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 no reason is documented.”

“It’s not just prescribers who should be questioned about their attitudes and beliefs about antibiotics”, continued Professor Baker. “It’s often patients themselves who, because they don’t understand that their condition will clear up by itself, or that perhaps antimicrobials aren’t effective in treating it, may put pressure on their doctor to prescribe an antibiotic when it is not indicated and they are unlikely to benefit from it.

“Research has shown that misconceptions about antimicrobial resistance are widespread. Many people think that it is their body which becomes resistant, rather than the bacteria that cause antimicrobial-resistant infections. This often makes it feel that the issue of resistance is someone else’s problem.

“The 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.”