NICE calls for review of individual antibiotic prescribing rates

NICE is calling for ongoing external review of antibiotic prescribing among individual healthcare providers in a bid to reduce creeping antimicrobial resistance.

A new draft guideline has been published for consultation and recommends setting up multidisciplinary antimicrobial stewardship teams working across all care settings. The teams would review prescribing and resistance data and feedback information to prescribers in order to understand the reasons for very high, increasing or very low volumes of antimicrobial prescribing. They would also provide "feedback and assistance to prescribers who prescribe antimicrobials outside of local guidelines where this is not justified".

NHS Prescription services' annual National Antibiotic Charts show that overall antibiotic prescribing in the community in England has been steadily increasing over several years. In 2013-14, over 40 million antibacterial prescriptions were issued at a cost to the NHS of £192 million. Despite considerable guidance that prescribing rates of antibiotics should be reduced, nine out of 10 GPs still feel pressured to prescribe antibiotics, and 97 percent of patients who ask for antibiotics are prescribed them.

Alastair Hay, Professor of Primary Care and chair of the committee which developed the guideline, said: "The more we use antibiotics, the less effective they become as diseases evolve and become resistant to existing antimicrobial medicines. Resistance to all antimicrobials is increasing and, combined with a lack of new antimicrobial medicines, there is a heightened risk in the future that we may not be able to treat infections effectively."

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, added: "This draft guidance recognises that we need to encourage an open and transparent culture that allows health professionals to question antimicrobial prescribing practices of colleagues when these are not in line with local and national guidelines and no reason is documented.

"But it’s not just prescribers who should be questioned about their attitudes and beliefs about antibiotics. It’s often patients themselves who, because they don’t understand that their condition will clear up by itself, or that perhaps antibiotics aren’t effective in treating it, may put pressure on their doctor to prescribe an antibiotic.

"The draft guideline therefore recommends that prescribers take time to discuss with patients the likely nature of their condition, the benefits and harms of immediate antimicrobial prescribing, alternative options such as watchful waiting and/or delayed prescribing and why prescribing an antimicrobial may not be the best option for them – for example, if they have a self-limiting respiratory tract infection. The draft guideline also recommends that patients are given advice about who they should contact if they have concerns about infection after discharge from hospital."

Dr Maureen Baker, Chair of the Royal College of GPs, said: "GPs can come under enormous pressure from patients to prescribe antibiotics so we welcome a team approach to ensuring that this is done appropriately and that they are used responsibly. However, this must be done in an open and supportive way."

Publication of the final guideline is expected in July 2015.