Exclusive: GPs alter prescribing habits to beat antibiotic resistance

GPs have reduced prescribing of most antibacterial drugs that experts say should be restricted and protected to limit rising antibiotic resistance, analysis of data over the past decade reveals.

Prescription: GPs have reduced use of most protected antibiotics (Photo: JH Lancy)
Prescription: GPs have reduced use of most protected antibiotics (Photo: JH Lancy)

UK GPs have cut down on prescribing drugs the World Health Organisation (WHO) has prioritised for protection, NHS Digital data on antibacterial drugs dispensed in the community suggests.

The WHO launched its updated Essential Medicines List last week, which included a new method of categorising antibacterials used to treat common infections into three groups – access, watch and reserve.

It recommended that only drugs in the ‘access’ group should be readily used as first- or second-line options for common infections, while drugs in the ‘watch’ group have higher resistance potential and should be used more sparingly.

Those in the ‘reserve’ group should treated as last-resort options to be used when other alternatives have failed, it recommended.

Antibiotic prescribing

Analysis by GPonline of official prescribing data over the last decade shows that GPs have already made a significant effort to cut down on drugs prioritised for protection in the WHO’s ‘watch’ list, which includes quinolones, 3rd-generation cephalosporins and macrolides.

GPs have slashed use of norfloxacin by 99.9% over the last decade, cutting use from over 61,000 prescriptions in 2006 to just 47 in 2016. Use of cefpodoxime and nalidixic acid were also cut by 99.8% and 99.7%, respectively.

Use of erythromycin more than halved to 896,000 prescriptions in 2016, while levofloxacin halved to 19,600 and ofloxacin halved to 27,800.

The only drug that has risen in use over the last decade that is featured exclusively on the WHO’s 'watch' list is ertapenem sodium, which rose from 37 prescriptions to 1,110.

Prescriptions of drugs on the ‘access’ list has significantly decreased for some drugs, while others have been prescribed in much larger volumes over the last 10 years.

Ampicillin prescriptions dropped 91% to 2,120 prescriptions, cefalexin by two thirds to 855,000 and amoxicillin use fell by a more conservative 8% to 11.6m.

Antibiotic resistance

But use of doxycycline monohydrate tripled to 2.7m prescriptions, nitrofurantoin increased almost six-fold to 2.6m and clarithromycin use tripled to 2.4m.

Use of drugs on the 'reserve' list – aztreonam, daptomycin, linezolid and tigecycline – has increased over the last 10 years, but all were used in very low numbers.

The results suggest that overall the number of antibacterial drugs prescribed rose 4% from 2006 to 2016 – but use has dropped off 11% compared to 2012, the year with the highest proportion of overall drugs prescribed.

GPC clinical and prescribing subcommittee chair Dr Andrew Green said: ‘The WHO classification is useful, the problem of antibiotic resistance really is one of the main challenges of this century.

‘It is pleasing that GP prescribing of the "watch" drugs has decreased so markedly, this is due not only to the efforts of GPs but also the academics, microbiologists and public health doctors who have worked hard to keep this subject at the forefront of our minds.’

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