We doctors must lift our game on antibiotics

ab'c prescribing report

Today’s major report on Australia’s antibiotic prescribing makes fairly grim reading. The Antimicrobial Use and Resistance in Australia (AURA) report reveals the following:

  1. Almost half (46%) the population was prescribed an antibiotic in 2014.
  2. More than half of patients with colds, flu and respiratory illness who received antibiotics did not need one.
  3. Acute upper respiratory tract infections (colds) resulted in antibiotic prescription 47% of the time (data taken from a sample of 180 GPs).
  4. Prescribing rates for sinusitis, bronchitis and middle ear infection massively exceed evidence-based recommendations.
  5. A fifth of nursing home residents who receive antibiotics have no signs of infection.
  6. Of the 38% of hospitalised patients who receive antibiotics on any given day, a quarter of prescriptions were inappropriate.
  7. Of those receiving antibiotics as a preventative measure around the time of their surgery, 40% of prescriptions were inappropriate.

When this sort of stuff hits the medical media, the response of a few doctors is to dig in, defend our position, and blame the messenger.

I pre-empted this with my own response below, which I have just sent out to GPs via my Medical Observer column. The main message is that we must do something to change.

Antibiotic overprescribing

It’s not hard to feel that GPs are under the pump, with rebate freezes and various reports suggesting we are using medical interventions too much or too little.

In this context, some will dismiss this latest antibiotic report as just another criticism, wishing the data had never been made public.

However, the quality of a profession can, at least in part, be judged by its response to criticism. And I reckon the best response to this report will be via our collective prescription pads.

We might rightly argue that our hospital colleagues are doing equally badly – a quarter of hospital antibiotics were judged to be inappropriate, and surgical prophylaxis was inappropriate 40 per cent of the time. Yet 88% of all antibiotic prescriptions originate from GPs, so we can’t deflect it as ‘someone else’s problem’.

We could also point to individual cases where an antibiotic might be indicated for an acute URTI, where general guidelines do not apply. Yet the report already accounts for this, allowing up to 20% antibiotic use as acceptable for URTIs. It found that our actual prescribing rate was 47 per cent.

No matter which way we might try to dismiss it, treating almost half of all colds with an antibiotic is unacceptable. Regardless of patient pressure, time pressure, inexperience, threat of litigation or any other mitigating factors, we need to do far better. Indeed, for every GP already doing far better, the law of averages suggests there is another GP consistently prescribing antibiotics for nearly all viral colds.

We are a science-based profession, and it would be good to stay that way. When something appears to be going fundamentally wrong with our collective practice, let’s not shoot the messenger or duck the public criticism.

Sure, let’s spend some degree of effort correcting public misconceptions about how easy it is to be a GP. But only if, at the same time, we are driving change from within. We need to improve.

About Dr Justin Coleman

Justin is a GP working in Aboriginal health in Brisbane, Australia. He is also a medical writer, editor and blogger. Further details at https://drjustincoleman.com/
This entry was posted in medical education and tagged , , , . Bookmark the permalink.

2 Responses to We doctors must lift our game on antibiotics

  1. Timely and appropriate call to action, thanks Justin. On antibiotic resistance, I really enjoyed this recent podcast from the RACP. https://www.racp.edu.au/pomegranate/View/episode-6-antibiotic-resistance-are-we-all-doomed

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