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Professor Chris Butler comments on recent research findings on BBC Radio 4’s Inside Health.

One in ten antibiotic prescriptions 2018fail2019 in general practice

More than one in ten of all antibiotic treatments in the primary care setting are associated with failure, according to research recently published in the BMJ.

A study of antibiotic treatment failure rates in primary care from 1991–2012 for four common infection types, which analysed almost 11 million antibiotic UK prescriptions, shows the failure rate has increased by 12% overall and continues to rise.

The increase in acute antibiotic treatment failure was of greater concern for certain infections, for example lower respiratory tract infections, which increased by 35%.

The study published this week was a joint project between researchers at Cardiff University's School of Medicine and the University of Oxford's Nuffield Department of Primary Care Health Sciences.

Much data has been gathered about antibiotic resistance in hospitals, yet the frequency and pattern of antibiotic failure in primary care has been far less well studied.

Treatment failure rates for commonly prescribed antibiotics in primary care, such as amoxicillin, penicillin and flucloxacillin remained below 20% throughout the studied period, while antibiotics not normally recommended for first-line therapies showed concerning rates of effectiveness. Most notably, trimethoprim, an antibiotic normally used in the treatment of upper respiratory tract infections and listed on the World Health Organisation's register of ‘essential medicines’, showed a failure rate of 40% when used to treat acute otitis media.

The period which saw the biggest increase in antibiotic failure - 2000 to 2012 – corresponds with a rise in antibiotic prescriptions in the UK. During this time the proportion of patients with infections who were given antibiotics rose from 60% to 65%.

Speaking on BBC Radio 4 Inside Health, study author Professor Chris Butler, GP and Professor of Primary Care, Nuffield Department of Primary Care Health Sciences, commented:

“People are getting older and frailer in the community; we are using these antibiotics more often for those who consult and treatment failure has increased dramatically, especially for lower respiratory tract infections. It’s a serious problem because we also found that the number of antibiotic prescriptions in the community is going up despite all the publicity and public concern on this issue.

“However, the good news story is that fewer people are consulting for respiratory tract infections - so the public are getting the message that they generally don’t need to consult for these common infections. Also, GPs are more often prescribing first line recommended antibiotic agents when they do decide an antibiotic prescription is necessary."

Lead researcher, Professor Craig Currie from the School of Medicine, Cardiff University said:

"There is a strong link between the rise in antibiotic treatment failure and an increase in prescriptions. Given the lack of new antibiotics being developed, the growing ineffectiveness of antibiotics delivered through primary care is very worrying indeed. There is a mistaken perception that antibiotic resistance is only a danger to hospitalised patients, but recent antibiotic use in primary care is the single most important risk factor for an infection with a resistant organism. Furthermore, what happens in primary care impacts on hospital care and vice versa.” 

Listen to the interview on BBC Radio 4 Inside Health (1:15 on the clock)

Antibiotic treatment failure in four common infections in UK primary care 1991-2012: longitudinal analysis.
Currie CJ, Berni E, Jenkins-Jones S, Poole CS, Ouwens M, Driessen S, de Voogd H, Butler CC, Morgan CL
BMJ 2014;349:g5493