Individual patients at risk of resistance after antibiotic script
ROUTINE antibiotic use not only contributes to community-wide antibiotic resistance, it also results in resistance to bacteria at an individual patient level.
A systematic review of prescribing in primary care found that patients given antibiotics were more than twice as likely to experience subsequent urinary tract and respiratory infections caused by resistant pathogens. And this resistance, which was more common with an increased number and duration of courses, could often last up to a year.
The UK researchers, themselves GPs, suggested clinicians were aware of the problem of antibiotic resistance but considered it a population-level issue that did not impact on daily practice.
Dr Thomas Gottlieb, president of the Australasian Society for Infectious Diseases, agreed, saying the study was an important reminder about judicious use.
He said Australian therapeutic guidelines offered a conservative approach to prescribing but antibiotics were nonetheless overused – particularly for asymptomatic UTIs in the elderly.
“Antibiotic resistance begins in individuals. It’s not a social problem, it’s an individual prescribing problem,” he said.
The review and meta-analysis included 24 observational and randomised trials. Patients with UTIs given antibiotics were 2.5 times as likely to develop resistance within two months and 1.3 times as likely within 12 months.
For respiratory tract infections, antibiotic prescription was linked to more than double the increased risk of resistance at both two and 12 months.
The National Prescribing Service has run educational programs for both health professionals and the public, promoting “common sense” as the treatment for common colds.
“We recommend all prescribers review their prescribing patterns for viral respiratory tract infections, and remind patients [who] expect antibiotics that illnesses due to viruses such as common colds, acute bronchitis and influenza are not shortened or symptoms lessened,” said CEO Dr Lynn Weekes (PhD).
Meanwhile, a study in Dutch general practices found recurrent, symptomatic UTIs were twice as common in women with diabetes as in those without.
The authors suggested GPs a employ a more tailored approach to antibiotic prescription in women with diabetes.
BMJ 2010;340:c2096; Fam Pract, online