Public Release: 

Online support for GPs reduces unnecessary antibiotic prescriptions

King's College London

New research from King's College London, published today in The BMJ, shows that electronically-delivered prescribing feedback and online decision support for GPs reduces unnecessary antibiotic prescriptions for respiratory illness.

NHS prescribing data show that UK GPs prescribe approximately 1.8 million courses of antibiotics every month to treat respiratory infections such as coughs, colds, bronchitis, otitis media, sinusitis and sore throat, at a cost of about £9 million[1]. Antimicrobial resistant infections currently claim at least 50,000 lives each year across Europe and the US alone and 700,000 globally[1][1]. These figures are set to rise to an estimated 10 million deaths per year by 2050 which would represent a greater death toll than cancer and diabetes combined.

The team from King's College London's School of Population Health & Environmental Sciences conducted a year-long trial including 79 general practices across the UK. GPs in the intervention trial arm received a short training webinar, monthly feedback reports of their antibiotic prescribing for respiratory illness and online access to decision support materials. The trial analysed the anonymised electronic health records of more than 500,000 patients.

Results showed that antibiotic prescribing was reduced by 12% overall with one antibiotic prescription avoided for every 62 patients aged 15 to 85 years. There was no evidence that serious bacterial complications, including pneumonia or scarlet fever, were increased. GPs did not reduce antibiotic prescribing to children (under 15 years) or to older adults (85 years and older). The authors note that antibiotic prescribing in these groups requires further evaluation.

Decision support tools included information leaflets for patients and carers on the expected duration of symptoms, recommendations for self-care and guidance on when to seek help again if needed. They also reminded GPs when antibiotics should and should not be prescribed.

Lead author Professor Martin Gulliford, Professor of Public Health at King's College London said: "Misuse of antibiotics is putting us all at risk. Taking antibiotics when they are not needed is leading to the emergence of resistant infections that can be very difficult to treat.

"This trial showed that providing GPs with information about their use of antibiotics for respiratory illnesses led to a reduction in antibiotic use. If this approach is scaled up nationally, it could contribute to reducing the emergence of antibiotic resistance."

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The trial was conducted using the anonymised electronic health records of general practices contributing to the UK Clinical Practice Research Datalink (CPRD). It was funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme.

Notes to Editors:

[1] Source: Open Prescribing. https://openprescribing.net/all-england/

[1][1] Source: House of Commons. Health and Social Care Committee. 2018. https://publications.parliament.uk/pa/cm201719/cmselect/cmhealth/962/96204.htm

Clinical Practice Research Datalink (CPRD) is a real-world research service supporting retrospective and prospective public health and clinical studies. CPRD is jointly sponsored by the Medicines and Healthcare products Regulatory Agency and the National Institute for Health Research (NIHR), as part of the Department of Health and Social Care.

About the NIHR:

The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:

* Funds, supports and delivers high quality research that benefits the NHS, public health and social care

* Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research

* Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future

* Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services

* Partners with other public funders, charities and industry to maximise the value of research to patients and the economy

The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR commissions applied health research to benefit the poorest people in low- and middle-income countries, using Official Development Assistance funding.

This work uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to this data. The NIHR recognises and values the role of patient data, securely accessed and stored, both in underpinning and leading to improvements in research and care. http://www.nihr.ac.uk/patientdata

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