GPs not following antibiotics prescribing guidelines

Australian GPs are prescribing antibiotics for acute respiratory infections at rates 4-9 times higher than recommended by Therapeutic Guidelines.

The findings from the Bettering the Evaluation and Care of Health (BEACH) study are the first to quantify the extent of the problem.

The study found about 5.97 million cases of acute respiratory infections were managed with at least one antibiotic each year. This volume could have been reduced to 0.65-1.36 million with adherence to national prescribing guidelines.

Co-author Professor Chris Del Mar from the Centre for Research in Evidence-Based Practice at Bond University, told the limbic primary care had to be the focal point for change.

“Antibiotic resistance is an inevitable consequence of antibiotic use. 20 years ago antibiotic resistance was generated in hospitals. Now, it’s walking through the door; generated in the community.”

“In general practice, about half of all antibiotics prescribed are for acute respiratory infections. We can reduce their use in acute respiratory infections more than almost anywhere else.”

The study found prescribing rates as high as 89% for acute otitis media and 94% for acute pharyngitis or tonsillitis. Guidelines suggest it would be appropriate to prescribe antibiotics for 20-31% of the ear infections and 19-40% of sore throats.

Professor Del Mar said other countries such as Sweden and the Netherlands had shown it was possible to safely use less than half of the volume of antibiotics used in Australia.

“What our paper has shown is the significant potential for improvement.”

Professor Del Mar said community and professional education initiatives such as those by the RACGP and NPS remained important long-term strategies to reduce inappropriate prescribing of antibiotics.

“The solution is not just education but specific tips and skills that GPs can acquire. For example, delayed prescribing – giving scripts to patients but telling them to hold off for a few days – can significantly reduce antibiotic use.”

“It teaches patients that they don’t always need antibiotics but they also feel looked after and supported.”

An unexpected finding was that only 72% of patients with community acquired pneumonia and 71% of patients with pertussis were being prescribed antibiotics when guidelines recommend they should always be used.

Professor Del Mar said a possible explanation was that patients with pneumonia were being referred to hospital and therefore not being treated with antibiotics by the GP.

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