Prescribing antibiotics

a battle of resistance

There is no single solution to the rapidly progressing problem of antibacterial resistance. Although various strategies are being implemented worldwide, between 2000 and 2010  link consumption of antibiotics increased by 36%. Discovery of new antibiotics is a necessary but not sufficient solution because of the high cost and lengthy timelines. Thus, action to control prescription practices should be a key feature of intervention strategies.

In 1998, the UK Department of Health link  reported that 80% of antimicrobial prescriptions for patients took place in the community and so recommended cessation of prescriptions for simple coughs and colds. In 2010, link  the Health Protection Agency (now Public Health England) expanded this guidance in a report detailing which antibiotics should be prescribed by doctors per condition and when. Prescription for acute respiratory infections, such as sore throat, was to be avoided. Unfortunately, data published earlier this month for 3·8 million patients in 537 general practices in the UK showed that the proportion of patients prescribed antibiotics for coughs and colds had risen from 35·5% in 1995 to 50·8% in 2011. But it is possible to change prescribing practice: in 2001, France started a national campaign to reduce use of antibiotics and by 2007 prescriptions had decreased by 26%. The benefits of sharing experience between policy makers and countries is considerable.

Inappropriate prescription is a greater problem in countries undergoing rapid economic expansion. In Bangladesh, China, and Thailand antibiotics are repeatedly indicated for self-limiting diarrhoeal infections and in India for viral dengue fever. In such countries where antibiotics were previously inaccessible and unaffordable, over-the-counter and incentive-driven prescriptions have elevated antibiotic consumption. In low-income countries, antibiotics are given as a substitute for provision of clean water and safe waste disposal.

Surveillance of antibiotic resistance and consumption is globally weak or non-existent. However, before bacteria win the battle and currently treatable infections become fatal, prescribers, patients, policy makers, and governments need to take responsibility to ensure that antibiotics are used far more rationally.

The Lancet, Volume 384, Issue 9943, Page 558, 16 August 2014