Antibiotic overprescribing: who are the bad guys?

The July Journal includes many articles on trying to reduce antibiotic prescribing in respiratory infections.1–5 May I bounce back a few obstacles?

Azithromycin to be taken three times a week? We have a growing cohort from secondary care of people with chronic airways disease, emphysema, and now also asthma, including children, who are put on this long term. Flares of chronic airways disease are poorly defined but antibiotics are considered good for this.

New syndromes like persistent wet cough in childhood seem to benefit from antibiotics. Ear, nose, and throat surgeons believe antibiotics work in sinus pain, despite vague NICE advice that seems to apply to primary care only.

There seems to be an epidemic of apparent urine infections diagnosed and treated with antibiotics in any ill older person in casualty. Any residential home resident where the staff can ‘dip urine’, and prescribing allied professionals are perhaps greater causes of current questionable prescribing.

Ill, hot children who attend hospital in our area always come out on antibiotics, usually co-amoxiclav.

All this makes it hard to stem the tide of antibiotic overuse. Add to this the failure of European or worldwide regulators to reduce pharmacy dispensing without prescription and it makes me wonder why we, as GPs, are seen as the bad guys.

The article on pharmacy advice also contrasts with the practice in southern Europe, where pharmacies appear to be pretty willing to sell antibiotics.

• © British Journal of General Practice 2013