HSE: Up to Half of All Antibiotic Prescriptions Inappropriate

March 7, 2012 Updated: September 29, 2015

In light of the recent information campaign by the Health Service Executive highlighting the dangers and costs of inappropriate antibiotic use, The Epoch Times asked the HSE why the campaign has been targeted at patients, rather than doctors? If patients need prescriptions to get antibiotics, how can they be causing the problem? Are Irish GPs over-prescribing these drugs, and if so, why?

EPOCH TIMES: How prevalent is the use of antibiotics for illnesses that they are not necessarily designed to treat?

HSE: Numerous studies have shown that half of all antibiotic prescriptions may not be appropriate, e.g. incorrect choice of antibiotic, incorrect dose/duration, or prescription of an antibiotic for infections where they are likely to be ineffective.

EPOCH TIMES: How can patients be causing the problem if they need a prescription to get antibiotics?

HSE: Numerous studies have shown that there is a high level of misunderstanding about the role of antibiotics in treating common infections among patients and the general public. This, in turn, can lead to a demand for, or expectation of, an antibiotic prescription by people attending their GP. As a result, studies have shown that prescriber education alone (mainly GP) does not produce a sustained reduction in inappropriate antibiotic use: patient and public education is needed as well. Data from other countries show that for many conditions (particularly upper respiratory infections, or coughs & colds), antibiotics are prescribed when they are not needed in up to 50 per cent of patients. We know that public expectation and pressure can influence prescribing decisions, and that public education has been shown to be an essential component in reducing inappropriate antibiotic use. 

A Europe-wide survey, which included Ireland, showed that members of the public often mistakenly believe that antibiotics can hasten recovery from upper respiratory tract infections and prevent more serious illness. Such misconceptions were lower in countries that have succeeded in maintaining low levels of inappropriate antibiotic use. Surveys have shown that nearly half of the adults that go to their doctor expect an antibiotic once they get there. In the US, between a third and half of parents with children presenting with mild respiratory symptoms said that they expected an antibiotic for a cough or cold.

Belgium has run a successful public education campaign, starting in 2004, mainly targeting antibiotic use for respiratory tract infections during the winter months. The campaign utilises television, radio and print advertising, leaflets, posters and a dedicated website. Analysis of the campaign’s impact has shown that the television advertising component has the greatest impact, with 79 per cent of those who were aware of the campaign citing the television advertisements. The campaign was associated with a 36 per cent reduction in community antibiotic consumption, with an associated reduction in the level of resistance among strains of pneumococcus. The campaign delivered approximately 4 million euro savings in direct drug acquisition costs to the Belgian health system, compared to an annual campaign budget of 400,000 euro.

In France, a national public education campaign was run for six months each year (autumn/winter) from 2002 to 2007. The key message of the campaign was that “antibiotics are not automatic”, and was delivered through a combination of humorous television and radio advertisements, print leaflets and press releases. Post-marketing surveillance demonstrated a significant improvement in public knowledge about antibiotic resistance and the importance of only using antibiotics when they are needed. The campaign resulted in a 23.4 per cent decrease in community antibiotic use (34 per cent for children under 15). During the same time period, there was a 29 per cent reduction in the level of penicillin resistance among strains of S. Pneumonia. The campaign had an annual budget of 4 million euro, but delivered a cost saving of 850 million euro to the French health system.

The current HSE information campaign theme is to stress that ‘Antibiotics are wasted on colds and flu,’ and includes an updated information leaflet for patients on antibiotics, a ‘no prescription for antibiotics’ prescription pad, a dedicated antibiotic section on the HSE website, and a radio ad.

EPOCH TIMES: Are GP’s over-prescribing or prescribing for incorrect use?

HSE: A major component of the joint Royal College of Physicians of Ireland (RCPI) and HSE healthcare-associated infection (HCAI) clinical care programme will be prevention of HCAI and antibiotic stewardship. The GP prescribing guidelines, which are evidence-based, have recently been updated and widely disseminated to a variety of primary care settings. Guidelines are important as they help standardise prescribing and ensure that each patient receives the correct drug as per the latest international evidence. In addition, they help GPs choose narrow-spectrum rather than broad-spectrum antibiotics, which may help prevent antibiotic resistance development. The RCPI clinical advisory group as part of its HCAI strategy is working with GPs and the HSE to develop surveillance in primary care to ensure that there is information on antibiotic resistance trends available to GPs for common infections, e.g. urinary tract infections.

EPOCH TIMES: What else is the HSE doing to raise awareness of the issue?

HSE: We are tackling antimicrobial resistance by reducing unnecessary antibiotic use. We do this by educating and changing the behaviour of prescribers and patients via antibiotic stewardship and public education. We also have systems in place to track emerging trends (i.e., surveillance such as EARS-net and antibiotic consumption surveillance). This ensures that we keep antibiotics for when we need them, reducing bacterial ability to develop resistance. It also means we can save money for both the health system and the patient. 

EPOCH TIMES: What savings, both financially and health-wise, can be made by the correct use of antibiotics?

HSE: Antibiotic use peaks every winter, during cold and flu season. That should make sense, but it doesn’t – colds and flu are caused by viruses, and are not killed by antibiotics. Using antibiotics for illnesses like these when they are not needed is a waste of money, drives antibiotic resistance, can have adverse effects on patients, and has a long term cost to our society and our future. Antibiotic resistance represents a global public health threat, and is associated with increased illness, death and financial cost related to infections. If left unchecked, rising antibiotic resistance threatens to undo many of the medical advances of the past 50 years.

Antibiotic expenditure represents a significant cost to the Irish healthcare system, so reductions in antibiotic use when appropriate can save money. More importantly, correct use of antibiotics is important:

– to ensure our patients get the best care (i.e., that a patient that needs an antibiotic gets the correct one, and also that if somebody does not need an antibiotic, e.g. for a cold or flu, that they take rest, fluids and eat well, consider an over-the-counter remedy to help symptoms such as aches and pains, but don’t get an antibiotic for this indication)
– because taking an antibiotic when it is not needed runs the risk of side effects from the antibiotic
– because with increasing use of antibiotics, some bacteria which cause infection build up resistance, and as a result, antibiotics are less effective (known as ‘antibiotic resistance’).

EPOCH TIMES: Many thanks for the information.

HSE: Thank you