Medicine being ‘inappropriately’ prescribed could become ‘biggest threat to global health’, say experts
DOCTORS are prescribing antibiotics for tens of thousands of patients with infections, with little or no consideration of prognosis and the risk of the infection worsening, say researchers.
Many younger people are being prescribed antibiotics, despite being fit enough to recover from their condition without them, a new study by University of Manchester epidemiologists found.
This could lead to antibiotic resistance, “the biggest threat to global health“, say the researchers.
On the other hand, older people, who may not be able to deal with infections as easily without antibiotics were found to not receive them as much.
Without the help of antibiotics, many older people face more serious health complications and hospitalisations, the epidemiologists found.
Professor Tjeerd van Staa, one of the lead authors of the study, said: “Antibiotics are effective in treating bacterial infections, but they carry the risks of antimicrobial resistance (AMR) and loss of effectiveness when used inappropriately.
“That is why AMR to antibiotics has been recognised as one of the biggest threats to global public health.
“Given the threat of resistance, there is a need to better target antibiotics in primary care to patients with higher risks of infection-related complications such as sepsis.
“But this study finds that antibiotics for common infections are commonly not prescribed according to complication risk and that suggests there is plenty of scope to do more on reducing antibiotic prescribing.”
The study, that involved looking at 15.7 million patient records, funded by the National Institute for Health and Care Research and published in the Journal of the Royal Society of Medicine earlier this month, suggests far fewer antibiotics could be prescribed.
The researchers found the probability of being prescribed antibiotics for a lower respiratory tract or urinary tract infection had no link to any risk of hospitalisation.
And the probability of being prescribed an antibiotic for an upper respiratory tract infection was only weakly related to the patient’s risk of being hospitalised.
The study also showed things like a patient’s age and the presence of other health problems were only weakly associated with the probability of being prescribed antibiotic treatment for a common infection.
Elderly patients in the sample were 31 per cent less likely than the youngest patients to receive an antibiotic for upper respiratory infections.
Patients with combinations of diseases were seven per cent less likely than people without major health problems to receive antibiotics for upper respiratory infections, added the researchers.
Dr Ali Fahmi, the study’s other lead author, added: “Rather than imposing targets for reducing inappropriate prescribing, we argue that it is far more viable for clinicians to focus on improving risk-based antibiotic prescribing for infections that are less severe and typically self-limiting.
“Prognosis and harm should explicitly be considered in treatment guidelines, alongside better personalised information for clinicians and patients to support shared decision making.”
The NHS says antibiotics should only be prescribed to treat health problems:
- that are not serious but are unlikely to clear up without antibiotics – such as acne
- that are not serious but could spread to other people if not promptly treated – such as the skin infection impetigo or the sexually transmitted infection chlamydia
- where evidence suggests that antibiotics could significantly speed up recovery – such as a kidney infection
- that carry a risk of more serious complications – such as cellulitis or pneumonia
Antibiotics may also be recommended for people who are more vulnerable to the harmful effects of infection, such as people over the age of 75, people with heart failure, and people with a weakened immune system.
Antibiotics are normally recommended if you’re having a type of surgery that carries a high risk of infection, and are sometimes given as a precaution to prevent, rather than treat, an infection.
Antimicrobial resistance (AMR)
ANTIMICROBIAL Resistance is a serious global public health threat where microorganisms like bacteria, viruses, fungi, and parasites become resistant to the effects of antimicrobial medicines, including antibiotics.
This resistance makes infections harder to treat, increases the risk of disease spread, and could lead to severe illness and death.
The World Health Organisation (WHO) declared AMR as one of the top 10 global public health threats, and listed it on the UK Government’s National Risk Register.
In 2019 there were 4.95 million deaths associated with bacterial AMR across 204 countries, and 1.27 million of those were directly attributed, leading the WHO to declare it a top global public health threat.
While resistance is a natural phenomenon and not just a health issue, from a human healthcare perspective, the NHS says it’s accelerated by:
- inappropriate use of antimicrobial drugs
- poor infection prevention and control practices
- a lack of new antimicrobial drugs being developed
- insufficient global surveillance of infection rates.
We rely on antibiotics, antifungals, and antiparisites to treat the microorganisms that cause many common diseases, such as tuberculosis (TB), HIV / AIDS, malaria, sexually transmitted infections, urinary tract infections, chest infections, bloodstream infections and food poisoning.
These microorganisms, however, can already resist a wide range of antimicrobial medicines.
The NHS says the following can help tackle resistance:
- early prevention of infections
- timely, accurate diagnosis
- appropriate prescribing and use of antimicrobials only when there is an infection for which they are the most appropriate treatment
- effective management of infections
- development of alternatives to current antimicrobials.