GPs admit to over-prescribing antibiotics
Irish family doctors admit to regularly over-prescribing antibiotics for acute respiratory infections, according to a new study.
Researchers at the University of Limerick found GPs often felt pressurised to prescribe antibiotics for such illnesses, particularly for fee-paying patients and in out-of-hours situations, despite being aware that antibiotics were inappropriate for the treatment of non-bacterial infections. Other international studies have shown that acute respiratory tract infections are the most common ailment for which antibiotics are prescribed in Europe, although their benefit is marginal in most cases.
They also estimate that 75% of all antibiotics are prescribed by family doctors. One of the authors of the latest study, Jane O’Doherty, of the medical school at the University of Limerick, said the aim of the research was to investigate why Irish GPs continued to prescribe antibiotics for acute respiratory tract infections “despite widely publicised guidelines and evidence about their ineffectiveness”.
Detailed interviews with 13 family doctors showed a high level of awareness among GPs that antimicrobial resistance — the ability of micro-organisms to be resistant to antibiotics — is a real threat to public health.
They said they did not regard existing HSE guidelines on the use of antibiotics for treating respiratory infection as comprehensive as they did not clearly outline the best course of action for all conditions.
GPs also referred to how their prescribing pattern could be influenced by whether patients were fee-paying or medical card-holders.
Some said the issue was an ethical challenge as they found it difficult to let a private patient leave a consultation without giving them a prescription for an antibiotic.
“Can you imagine trying to send a private patient home with advice on paracetamol, rest and fluid for €50? A lot of them wouldn’t be pleased,” one doctor said.
GPs also acknowledged that they sometimes conceded to the demand from patients for antibiotics even though they knew it would not help their condition and could contribute to antimicrobial resistance.
Many said they used the tactic of giving patients delayed prescriptions with directions not to use it unless they were still feeling unwell several days later.
Ms O’Donnell said the study’s findings suggested the need for interventions to target the public’s perceptions of antibiotics.
She said the behaviour of GPs also needed to change to reduce antimicrobial resistance and alter the expectations of patients.
