Shropshire GP hits back over antibiotic criticism

Dr Mary McCarthy of Belvidere Medical Practice in Shrewsbury branded the crackdown as "unfair".

The National Institute for Health and Care Excellence (Nice) said that as many as 10 million prescriptions for antibiotics are being dished out unnecessarily every year, with patients partly to blame for purposely seeking out doctors who will prescribe the drug.

Q: What are antibiotics and how do they work?

A: Antibiotics are used to treat and sometimes prevent bacterial infections. There are hundreds of different types but most can be classified into six groups. Most, such as penicillin, work by destroying the cell walls of bacteria. Others stop bacteria from growing and multiplying. Most bacteria do not live long, so bacteria will die out once antibiotics start attacking them.

Q: What is antibiotic resistance?

A: Antibiotic resistance is when a strain of bacteria no longer responds to treatment with antibiotics.

Strains of bacteria can mutate and gradually become resistant to a specific antibiotic and the chances of this happening increases if a person does not finish the course of antibiotics as some bacteria may be left to develop resistance. This is why patients are always urged to take the full course of antibiotics, even if they feel better or they feel their symptoms have gone away.

The problem is fuelled by unnecessary prescribing of the drugs, as today's guidance highlights. It has also led to the emergence of superbugs – strains of bacteria that have developed resistance to many different types of antibiotics, such as MRSA (methicillin-resistant Staphylococcus aureus) and C diff (Clostridium difficile), which are responsible for thousands of deaths.

Q: What can be done to prevent this?

A: This latest guidance from the National Institute for Health and Care Excellence (Nice) follows previous initiatives and advice from the Government.

In 2014 David Cameron warned that 25,000 people a year are dying from infections resistant to antibiotic drugs in Europe, warning that if action is not taken, "we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine where treatable infections and injuries will kill once again".

At the same time, Chief Medical Officer for England, Professor Dame Sally Davies, described antibiotic resistance as a "catastrophic threat'' on a par with terrorism and climate change.

Professor Mark Baker, director of Nice, said "soft-touch" doctors who "fail to come into line" by continuing to unnecessarily prescribe antibiotics could be reported to the health regulator.

Dr McCarthy said she questions whether it is just GPs who are over-prescribing antibiotics and said it was wrong to target just one group.

She said: "Between 2010 and 2013, GPs prescribing antibiotics rose by four per cent, while prescribing hospital inpatients rose by six per cent and other community prescribers such as dentists rose by 32 per cent.

"I don't think it's the GPs that are the problem. You've got to look at all prescribers I think."

Nice published guidance for doctors, nurses and pharmacists to help tackle the problem, while it plans to issue advice for patients next year.

Dr Tim Ballard, vice chairman of the Royal College of GPs, said family doctors prescribe antibiotics even when it is not the best course of action following "very difficult and stressful" conversations with patients.

"We need a change in attitudes towards the use of antibiotics and any suggestion that hard pressed GPs – who are already trying to do their jobs in increasingly difficult circumstances – will be reported to the regulator is counter-productive and unhelpful," he said.

Health officials have warned of a growing "crisis" of antimicrobial resistance which could change the whole basis of medicine, with infections having to be treated surgically if drugs no longer work. Prof Baker said many patients expect antibiotics for common conditions such as colds, coughs, sore throats and even hay fever.

He said: "Most doctors prescribe sensibly and competently. For the relatively small number who are less disciplined, first we need to identify them, and that's what today's guidance deals with, and secondly I think there need to be processes locally to deal with them and make sure that either through education or other sanction that they behave in the same way as those who practice sensibly.

"Ultimately if they fail to come into line there is always recourse to the professional regulator and there are a number of performance processes that the General Medical Council or in the case of dentists the General Dental Council can use to improve the clinical performance."