Online support for GPs reduces unnecessary antibiotic prescriptions

NHS prescribing data show that UK GPs prescribe approximately 1.8 million courses of antibiotics every month to treat respiratory infections such as coughs, colds, bronchitis, otitis media, sinusitis and sore throat, at a cost of about £9 million. Antimicrobial resistant infections currently claim at least 50,000 lives each year across Europe and the US alone and 700,000 globally. These figures are set to rise to an estimated 10 million deaths per year by 2050 which would represent a greater death toll than cancer and diabetes combined.

The team from King's College London's School of Population Health & Environmental Sciences conducted a year-long trial including 79 general practices across the UK. GPs in the intervention trial arm received a short training webinar, monthly feedback reports of their antibiotic prescribing for respiratory illness and online access to decision support materials. The trial analysed the anonymised electronic health records of more than 500,000 patients.

Results showed that antibiotic prescribing was reduced by 12% overall with one antibiotic prescription avoided for every 62 patients aged 15 to 85 years. There was no evidence that serious bacterial complications, including pneumonia or scarlet fever, were increased. GPs did not reduce antibiotic prescribing to children (under 15 years) or to older adults (85 years and older). The authors note that antibiotic prescribing in these groups requires further evaluation.

Decision support tools included information leaflets for patients and carers on the expected duration of symptoms, recommendations for self-care and guidance on when to seek help again if needed. They also reminded GPs when antibiotics should and should not be prescribed.

Lead author Professor Martin Gulliford, Professor of Public Health at King's College London said: "Misuse of antibiotics is putting us all at risk. Taking antibiotics when they are not needed is leading to the emergence of resistant infections that can be very difficult to treat.

"This trial showed that providing GPs with information about their use of antibiotics for respiratory illnesses led to a reduction in antibiotic use. If this approach is scaled up nationally, it could contribute to reducing the emergence of antibiotic resistance."

The trial was conducted using the anonymised electronic health records of general practices contributing to the UK Clinical Practice Research Datalink (CPRD). It was funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme.