GPs prescribe broad-spectrum antibiotics to avoid “time-consuming tests”

A study finds that broad-spectrum antibiotics are prescribed due to a lack of resources for GPs – with “time-consuming microbiological tests” taking too long

NHS warnings fill headlines every winter since the pandemic. A burnt-out workforce wrestles with the virus, then with the shadow pandemics that it created and exacerbated. Cancer care, eating disorder treatment, veteran mental health, scheduled surgeries.

The Institute for Fiscal Studies say that the number of people waiting for treatment will rise to nine million, in 2022. This number will only decrease by 2025, but only if the NHS treats an additional 1.6 million people per year. This will mean an extra 2 billion per year needs to be invested into the NHS.

There are countless healthcare issues that are facing delays and resource deprivation, as the UK reels from two years of hospitalisation and death.

Firstly, what is antimicrobial resistance?

According to Josep Figueras and Anna Sagan from the European Observatory on Health Systems and Policies: “Antimicrobial resistance (AMR) is one of the urgent global health challenges of our times.

“AMR is the natural ability of microorganisms such as bacteria to become resistant to antimicrobial medicines. This Darwinian ability has always been present, and, in the past, we have responded to it by developing novel antibiotics and other antimicrobials. However, as global consumption of antibiotics in both humans and animals has increased and the antibiotic pipeline has dried up, AMR has increasingly put modern medicine under threat.”

Essentially, AMR is a point in time where crucial medicines for diseases stop working, because the diseases have evolved past them – but our medicines have no evolutions left in them.

The UK in general is prescribing low amounts of broad-spectrum antibiotics in comparison to other countries. However, this new finding still frames an interesting, troubling correlation between lack of resources and contribution to a global crisis.

GPs are prescribing broad-spectrum instead of narrow-spectrum

While broad-spectrum antibiotics cover – as implied – a range of medical issues, narrow-spectrum antibiotics are far more targeted. Narrow-spectrum antibiotics are therefore less likely to contribute to antimicrobial resistance, as they are less frequently and widely used.

This study, published in Medical Decision Making, was led by Dr Thomas Allen from The University of Manchester and Dr Anne Sophie Oxholm from the University of Southern Denmark.

Dr Allen said: “Our findings show that GPs who experience increased pressure, particularly from increased demands from patients and when trying to recruit new colleagues, increase their share of broad-spectrum antibiotics prescriptions.

“Until this study, evidence was scarce on the consequences of pressure on physicians’ decision-making.

“So our finding that increasing pressure may contribute to antimicrobial resistance, one of the largest threats to human health and society, is worrying.”

Prescriptions go up by 6.4%, as pressures on GPs increase

The percentage of broad-spectrum antibiotics prescribed increases by 6.4% as pressure on GPs does. The study further revealed that the greatest increase in prescribing this type of antibiotic happened with “increased demand from patients.”

It is known that pressures on GPs in the UK is generally high. Individuals are often texted by their practice, asking them not to book an appointment for anything non-urgent during times of extreme demand.

The six sources of pressure used to investigate this antibiotics issue are:

1. Increased demands from patients;
2. Not having enough time to do the job;
3. Insufficient resources;
4. Long working hours;
5. Paperwork;
6. And attempts to recruit more GPs.

The researchers say that between 2010 and 2017, the percentage of GPs reporting high or considerable pressure from demand from patients increased from 65% to 84%. These numbers were taken pre-pandemic, which further extolled patient demand.

How can this issue be solved before it has major impact?

Dr Oxholm further commented: “Policymakers need to take these consequences into account when evaluating existing policies as well as when introducing new policies affecting physicians’ work pressure.”

“One way to address these consequences could be to design policies reducing pressure on GPs. Another potential way could be to educate or remind both patients and physicians on the advantages of choosing the socially optimal treatment, for example through information campaigns .”

“In general, other ways to affect medical decision-making could be through enforcing new regulation, updating clinical guidelines, or introducing incentive schemes.”