Opinion Former Article

Training and education for prescribers and information for patients must be implemented to halt the rise of superbugs and over-prescribing of antibiotics

MRSA Action UK welcome the NICE guidance on antimicrobial stewardship, and in our response to NICE, have emphasised the need for better diagnostics so that when someone does need treatment they get the right targeted antimicrobial if its required.

We believe there must be an increase in trained antimicrobial pharmacists working in both the community and hospital setting. Anyone responsible for caring for patients should have access to training and guidance, which can be provided by antimicrobial pharmacists.

We must stem the tide in antimicrobial resistance or we really could find ourselves back in the dark ages where the simplest of infections are untreatable.

There is significant variation in antimicrobial prescribing between GP practices and this shows the lack of understanding of the issues with both prescribers and patients. Education and information is absolutely key in getting the message across to everyone.

Doctors must spend more time explaining to their patients why they cannot receive antibiotics for minor infections. Some practices prescribe a lot of broad spectrum antibiotics that can cause other problems such as C.diff, short for Clostridium difficile, this can be life threatening and in a care environment lead to cross infection, so we can end up exacerbating the problem further, not only costing lives, but costing the NHS billions.

The National Institute for Health and Care Excellence (Nice) have said that the medical profession as well as patients need to realise that the continuing rise in antibiotic prescriptions needs to be reined-in by concentrating on the “sensible use” of antimicrobial drugs.

“We hope that by publishing these guidelines it will become more difficult to prescribe antibiotics inappropriately,” - Professor Mark Baker, director of the Centre for Clinical Practice at Nice.

The use of antibiotics has risen steadily over recent years with 41.6 million NHS prescriptions issued last year in England alone at a cost of £192m. Nine out of ten GPs say they feel pressurised to issue the prescriptions and 97 per cent of patients who ask for them are prescribed them. Between 20 and 30 per cent of antibiotics currently prescribed by the NHS are unlikely to benefit patients, for example because they are suffering from a throat virus – one of the most common reasons for taking a course of antibiotics.

As many as 10 million prescriptions – about a quarter of the annual total – are being given unnecessarily to patients who will not benefit from the drugs, Professor Baker 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,” he added.

Doctors will in future have to take into account the risk of antimicrobial resistance both for the patient and the wider population before issuing an antibiotic prescription. Hospital doctors will have to take microbial samples from patients suspected of infections before signing a prescription. NHS staff are being advised not to issue immediate prescriptions for a patient who is likely to have a self-limiting condition. Patients can be asked to come back within three or five days if their symptoms persist or they can be issued with date-delayed prescriptions.

We welcome this intervention, however training and guidance on antimicrobial stewardship is essential to ensure we don’t cause harm through fear of not prescribing when needed.

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