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GPs face new antibiotics pressure

Thursday February 28th, 2019

Pensioners with urinary tract infections should get rapid antibiotic treatment to reduce risk of sepsis, researchers say today.

Attempts to delay antibiotics are linked to a significant increased risk of death from sepsis, researchers report in The BMJ.

A second report in the journal highlights over-treatment with antibiotics – arguing that many patients are prescribed courses that last longer than guidelines recommend.

The first study, led by Professor Paul Aylin, of Imperial College, London, examined outcomes for 150,000 patients over the age of 65 diagnosed with UTIs over a recent eight-year period.

6% had antibiotic prescriptions delayed while 7% did not get antibiotics.

According to the analysis, there was one extra case of sepsis for every 37 patients who did not receive antibiotics and one extra case for every 51 patients who had deferred treatment.

These patients also faced a doubled rate of hospital admission.

The researchers point out the study is observational and there could be confounding factors explaining the increased rates of sepsis and admission.

But they say doctors should “consider early prescription of antibiotics for this vulnerable group of older adults, in view of their increased susceptibility to sepsis following UTI and despite a growing pressure to reduce inappropriate antibiotic use.”

The second study involved examining 931,000 consultations for 13 common conditions, mostly acute cough and acute sore throat.

The researchers from Oxford University and Brighton and Sussex Medical School say that prescriptions for 80% of respiratory conditions exceeded the recommended seven days.

The Royal College of GPs said the studies highlighted the conflicting pressures on GPs to manage their antibiotic prescribing.

Chair Professor Helen Stokes-Lampard said: “GPs are in an incredibly difficult position when it comes to antibiotics prescribing. We are under huge pressure not to prescribe - and publicly vilified when we are deemed to do so too readily - yet, we know that in some cases antibiotics are a matter of life or death.

“Getting the balance right every time is extremely challenging."

BMJ 28 February 2019

http://www.bmj.com/content/364/bmj.l525

http://www.bmj.com/content/364/bmj.l440

Tags: Elderly Health | Internal Medicine | Pharmaceuticals | UK News

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