Antibiotic doses on the rise – along with resistant infections

Clinicians need to be make 'informed' prescribing decisions, says RCN

The RCN has called on health professionals to make more 'informed' decisions to cut the amount of antibiotics they prescribe.

The college was responding to a report showing an increase in the incidence of infections resistant to antibiotics.

Public Health England concluded in its second English surveillance programme for antimicrobial utilisation and resistance report that although prescribers are writing fewer prescriptions for antibiotics they are prescribing longer courses and higher doses. 

Consumption of antibiotics prescribed in general practice increased 6.2% from 16.1 to 17.1 ‘defined daily doses’ per 1,000 of the population between 2011 and 2014.

Prescribing to hospital inpatients increased significantly by 11.7% (2.23 to 2.49 defined daily doses per 1,000 of the population) and to hospital outpatients by 8.5% (1.57 to 1.71 defined daily doses) between 2011 and 2014. 

The report described a continuing rise in the numbers of infections such as E. coli and Klebsiella pneumoniae, which are resistant to antibiotics.

Between 2010 and 2014, E. coli infection rates rose by 15.6% from 45 to 52 cases per 1,000 of the population.

Rates for K. pneumoniae increased by 20.8% from 7.7 to 9.3 cases per 100,000 people from 2009 to 2014. 

RCN professional lead for infection prevention and control Rose Gallagher said: ‘The rise in antibiotic resistance poses a significant threat to health care worldwide and this report highlights the need for urgent action.

'Preventing infections and making informed decisions about when treatment is needed is a good place to start.

'Slowing down the pace of resistance needs a co-ordinated strategy and the tools to implement it.’

She added: ‘We know that some GPs come under pressure to prescribe antibiotics because consultations are short and it is easier to prescribe than to talk patients through the alternatives.

'We don’t have any evidence that nurses are coming under this pressure. But nurses should be aware of over-prescribing.'

Ms Gallagher said nurses should refer to the Royal College of General Practitioners’ TARGET Antibiotics toolkit, which can be found here

Public Health England plans to bring down prescribing rates through initiatives such as the publication next year of prescribing patterns for different organisations. This will allow prescribers to compare their rates with their peers, the organisation says.

Report co-author and Public Health England healthcare epidemiologist Susan Hopkins said: ‘It is vital we tackle antibiotic prescribing across the population and ensure prescriptions are given only when they will make a difference to patient outcomes.’ 

Read the Public Health England report here


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