There is a need for standardized antibiotic prescribing across europe to battle resistance

There is a need for standardized antibiotic prescribing across europe to battle resistance

In a study published on, experts report that prescription of antibiotics for respiratory illnesses should be standardized across Europe in order to reduce unsuitable prescribing and resistance.

One of the major health care problems worldwide is antibiotic resistance. It is believed that inappropriate antibiotic prescribing for respiratory illnesses in particular is one of the causes, and that it fosters the problem. There is proof that most antibiotic prescriptions do not assist otherwise healthy patients with common respiratory tract infections to get well again any faster.

In order to find out more, researchers of the EU funded Network of Excellence GRACE looked at variations in antibiotic prescribing for acute cough across Europe, and the effects on recovery.

Patients were recruited for the study from fourteen care research networks in thirteen European countries (Wales, England, The Netherlands, Spain, Germany, Hungary, Belgium, Poland, Italy, Sweden, Norway, Finland and Slovakia). 3,402 adults were included in the research. They all had either a new or deteriorating cough or a possible lower respiratory tract infection.

For each patient, there was a description of medical history, existing conditions, symptoms and their management, including antibiotic prescription, and temperature. With the use of a recognized scoring scale, the severity of their symptoms was then rated.

During twenty eight days, patients also recorded and rated the severity of their symptoms, using symptom diaries.

In general, 53 percent of the patients had prescription for antibiotics. But across the networks, prescriptions ranged from 21 percent to nearly 90 percent. For example, patients in Slovakia, Italy, Hungary, Poland and Wales were at least twice more likely to be prescribed antibiotics than the general average. Whereas patients in Norway, Belgium and Sweden were at least four times less likely to be prescribed antibiotics than the general average.

There were still important differences when deciding whether or not to prescribe an antibiotic. They remained even after the researchers adjusted for symptoms, duration of illness, smoking, age, temperature, and co-morbidity (other existing conditions).

In addition, this dissimilarity in antibiotic prescribing was unrelated with clinically significant variations in patient recovery.

Also, the choice of antibiotic was noticeably different between the networks. In general, Amoxicillin was the most frequently prescribed antibiotic. However, the range was from 3 percent of prescriptions in Norway to 83 percent in England. The authors attribute those variations to the different guidelines and habits in each country.

This is a leading study in its category. The authors conclude that the findings indicate that management of acute cough is a concern that is suitable for standardized international care pathways promoting conservative antibiotic prescribing.

Professor Chris Butler, of Cardiff University, lead author of the study, explained: "This international collaborative research showed that the big differences in antibiotic prescribing between countries are not justified on clinical grounds. It therefore identifies a major opportunity for greater standardization of care across Europe."

Professor Herman Goossens of the University of Antwerp, coordinator of the GRACE Network of Excellence mentions: "This threat of antibiotic resistance is likely to be more acute as GPs face increasing demands to prescribe antibiotics for acute cough amidst the current global H1N1 flu pandemic. This new evidence should prove instrumental in containing antibiotic prescribing."

"Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries"

C C Butler, professor, K Hood, director, T Verheij, professor, P Little, professor, H Melbye, professor, J Nuttall, senior trial manager, M J Kelly, statistician, S Mölstad, professor, M Godycki-Cwirko, physician, J Almirall, professor, A Torres, professor, D Gillespie, trainee statistician, U Rautakorpi, senior medical officer1, S Coenen, postdoctoral fellow, H Goossens, professor

BMJ 2009; 338:b2242


Section Issues On Medicine: Other