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- RE: Antibiotic overuse: a key driver of antimicrobial resistance.Dr. Weiler correctly highlights some of the limitations of primary care prescribing data: Research databases such as the Clinical Practice Research Datalink (CPRD, formerly the GPRD) record information on issued prescriptions, prescribing analyses and cost (PACT) data records prescriptions that are dispensed. Neither of these methods will record the proportion of prescriptions that are actually taken by the patient and we are unaware of any research studies that have specifically addressed this important question. GPs can record delayed prescriptions using the Vision software system, but it is unclear how frequently this Read code is used.However, estimates suggest 80-90% of antimicrobials are prescribed in the community so even if we are overestimating antibiotic use, it is clear that the majority of antimicrobials are prescribed and dispensed in primary care. Research studies based on both issued and dispensed prescriptions using different populations all deliver the same message: there is major heterogeneity in prescribing, and this offers scope to reduce antibiotic use.1-3There is a clear need for better surveillance data on antimicrobial prescribing and resistance in hospitals and in primary care and this is the rationale behind the English Surveillance Program on Antimicrobial Resistance (ESPAUR).4 Optimising antibiotic use is a fundamental part of the response to antimicro...Show MoreCompeting Interests: None declared.
- RE: GP antibiotic overuse and microbial resistance: as bad as we think or much worse?I read the article on antibiotic overuse and resistance by Shallcross & Davies in last month’s BJGP1 with interest and doubt many would debate the conclusions, but have been left wondering the degree to which the robustness of the data supports the overuse of antibiotics in primary care.Many doctors may treat patients using delayed prescriptions,2 which can be a reasonable part of presumed viral illness management safety netting, yet are not reflected in the data because many will not be taken to a pharmacy and no read code for such a prescription exists in computerised note keeping systems. Furthermore, adherence to medication is very low3 and patient behaviours with green script in hand as they leave their surgeries suggest that many will not even take their prescription to a pharmacy and a huge chunk more will not take the medication at prescribed therapeutic doses. If the data from pharmacies does not reflect the indication for the prescription and cannot be linked to GP records, then is it possible to make public health inferences about the causes of antibiotic resistance being GP overprescribing of antibiotics for sore throats and viruses?If patient behaviours determine that the observational prescribing data should be considerably discounted, then either microbiological resistance pathways are much worse than we think, or we cannot conclude much at all,...Show MoreCompeting Interests: None declared.
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British Journal of General Practice
Antibiotic overuse: a key driver of antimicrobial resistance
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