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CMAJ • October 15, 2002; 167 (8)
© 2002 Canadian Medical Association or its licensors

Letters
Correspondance

Reducing antibiotic prescriptions

Azeem Majeed

Professor of Primary Care, University College London, London, UK

James Maskalyk highlights the importance of the judicious use of antibiotics in limiting the spread of antibiotic resistance.1 Family practitioners in England and Wales have responded to concerns about the overuse of antibiotics by reducing their prescribing rates.2 The number of antibiotic prescriptions issued by family practitioners decreased by 25% between 1995 and 2000, from 49.4 to 36.9 million prescriptions, corresponding to a fall from 1.00 to 0.75 antibiotic prescriptions per person per year. A more detailed data analysis from 210 family practices between 1994 and 1998 showed that antibiotic prescribing rates fell the most for children.2 A similar decline in antibiotic prescribing for children has also occurred in the US and elsewhere.3 Falling rates for children may reflect the fact that many guidelines on antibiotic prescribing are for upper respiratory tract infections and ear infections.4,5

In 1998, the Department of Health for England launched an initiative to reduce rates of antibiotic prescribing in community settings, but the change in prescribing practice predated the start of the program.6 This suggests that family practitioners were already aware of the need to reduce antibiotic prescriptions and the limited effectiveness of antibiotics for many common infections. However, the government's initiative has helped to maintain the downward pressure on prescribing rates. This experience shows that doctors can have a significant impact in reducing antibiotic prescribing rates, particularly when they are supported by the government in achieving this objective.

Azeem Majeed Professor of Primary Care University College London London, UK

References

  1. Maskalyk J. Antimicrobial resistance takes another step forward. CMAJ 2002;167(4):375. [Free Full Text]
  2. Wrigley T, Tinto A, Majeed A. Age- and sex-specific antibiotic prescribing patterns in general practice in England and Wales, 1994 to 1998. Health Stat Q 2002;14:14-20. Available: www .azmaj .org /PDF/Antibiotic.pdf (accessed 2002 Sept 17).
  3. McCaig LF, Besser RE, Hughes JM. Trends in antimicrobial prescribing rates for children and adolescents. JAMA 2002;287:3096-102. [Abstract/Free Full Text]
  4. Little P, Gould C, Williamson I, Moore M, Warner G, Dunleavey J. Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media. BMJ 2001;322: 336-42. [Abstract/Free Full Text]
  5. Little PS, Williamson I. Controversies in management: Are antibiotics appropriate for sore throats? Costs outweigh the benefits. BMJ 1994; 309: 1010-2. [Free Full Text]
  6. SMAC Sub-Group on Antimicrobial Resistance. The path of least resistance. London: Department of Health; 1998. Available: www .doh .gov .uk/smac1.htm (accessed 2002 Sept 17).




This Article
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