Pressure to cut antibiotic use contributing to outbreaks of scarlet fever, say GPs

One in three GPs are concerned that pressure to reduce the use of antibiotics is fuelling the recent rise in cases of bacterial diseases such as scarlet fever, a GPonline poll has shown.

Scarlet fever cases have risen over the past three years (Photo: iStock)
Scarlet fever cases have risen over the past three years (Photo: iStock)

A third (32%) of GPs believe that serious bacterial diseases including scarlet fever will become more common as a direct consequence of cutting down on antibiotic prescriptions, a GPonline poll of 307 GPs has revealed.

GPs expressed their worry that they are ‘damned if they do and damned if they don’t’ take measures to be stricter with antibiotics to help tackle the rising threat of antimicrobial resistance.

One GP warned that a rise in bacterial diseases was ‘the logical outcome’ of cutting down on antibiotics handed out to patients.

GPs have very successfully reduced antibiotic use in recent years, cutting down on prescribing by 7.3% over the last year, hailed as a ‘fantastic result’ by NHS leaders.

Incidence of scarlet fever is undoubtedly on the rise, with Public Health England (PHE) surveillance figures showing that the disease has surpassed record levels for three consecutive years.

Scarlet fever outbreak

During peak scarlet fever season this spring, cases reached a 34-year high of over 1,300 cases a week, the highest since records began in 1982.

‘There’s been loads of scarlet fever around this area recently,’ said one GP. ‘I'm sure it’s because we are actively discouraged from prescribing antibiotics for tonsillitis.’

Other bacterial diseases have also seen a resurgence, with incidence of syphilis rising 22% in 2015.

But GP leaders have reasserted cutting down on antibiotics ‘is no doubt the correct way to go’, even though a small number of patients may slip through the net and develop bacterial illness.

A slight majority of GPs (56%) said they did not think recent increases in bacterial illness were linked to efforts to limit antibiotic prescribing. A further 12% indicated that they did not know.

‘We have endemically overused antibiotics for too long,’ warned one GP. Another said they had not observed any rise in bacterial infections, ‘despite being the lowest prescriber in our locality’.

Dr Andrew Green, chairman of the GPC clinical and prescribing subcommittee, said: ‘There is absolutely no doubt that reducing antibiotic prescribing is the correct way to go, however it is inevitable that there will be a number of patients who develop bacterial illnesses subsequent to being advised no treatment was necessary.

‘It must be realised by all, including lawyers, patients, the media and the GMC, that these do not represent "missed diagnoses" but the proper application of medicine designed to protect the majority of the population from harm. I'm fully aware this is about as likely as Hull City winning the Premiership.’

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