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What is driving antibiotic over-prescription in the UK?

Posted on 13 January 2020 by Bernard Steen, Senior Researcher .
Tags: GPs, NHS, antibiotics, health, healthcare

Public concern about drug-resistant infections is high, but what is driving the over-prescription of antibiotics? Are cautious GPs writing unnecessary prescriptions, or do they feel under pressure from patients who might be misinformed? The fourth wave of the Wellcome Monitor offers new insights into this pressing issue.

Across Europe, it has been estimated that up to 25,000 people die each year due to hospital-acquired infections caused by five resistant bacteria including E. Coli, K. Pneumoniae and MRSA. Accelerated by the misuse and overuse of antibiotics, new drug-resistant infection (DRIs) are developing constantly, while existing ones are spreading.

Wellcome Monitor data, published in November 2019, shows that the British public are aware of the dangers: 56% of people say they have a good or very good understanding of the term ‘antibiotic resistance’, with only 6% saying they have not heard it at all. Over half (54%) think that DRIs are a very high risk to public health, more than for any other potential health risk that was asked about.[1]

Even so, a 2018 study compared clinical treatment guidelines against the actual outcome of GP consultations and found that between 9% and 23% of all antibiotics prescribed by GPs are given to patients who do not need them. Why are these antibiotics being prescribed? Are GPs offering antibiotics when they shouldn’t be, or are patients asking for antibiotics they don’t need? When patients ask for prescriptions they don’t need, do GPs refuse?

The Wellcome Monitor data shows that 42% of people have asked a GP or other medical professional to prescribe antibiotics. It is likely that in many of these cases antibiotics were unnecessary: only 43% of people correctly understand that only bacterial infections can be treated by antibiotics, and those with an incorrect understanding of the uses of antibiotics are no less likely to have asked for a prescription.

Of those who asked for a prescription, a large majority were given one (86%). People with an incorrect understanding of antibiotics were twiceas likely to have had to persuade their GP to write their prescription compared to those with a correct understanding (14% compared to 7%), suggesting GPs may find refusing antibiotics challenging.

The issue therefore appears two-fold: on the one hand, despite concern about DRIs, the public is unclear about when antibiotics should be used; on the other GPs, are rarely refusing to prescribe.

This suggests that strategies to reduce antibiotic over-prescription should address both sides of the issue. Public health campaigns should focus on improving understanding of the uses of antibiotics, and there is evidence from the Monitor report to suggest that these strategies would be best targeted at younger people: those aged 18 to 29 were least likely to have an accurate understanding of antibiotics, most likely to have asked for a prescription, and most likely to have had to persuade their GP. At the same time, efforts should be made to encourage GPs to push back when they believe patients are asking for prescriptions they don’t need.

Antibiotic resistance is now amongst the world’s most pressing public health challenges. The number of dying globally each year due to DRIs is predicted to rise to 10 million by 2050. The Wellcome Monitor makes a valuable contribution to understanding the driving factors behind antibiotic resistance in Britain.

The fourth report in Wellcome’s Monitor series was published on 18 November 2019, providing timely measures of our attitudes to pressing health issues, including mental health, vaccinations, and DRIs. The latest wave was conducted either online or over the phone, with a representative sample of 2,708 British adults recruited from the NatCen Panel – the first probability-based research panel in Britain that is open to be used by the social research community.

[1] Which includes: air pollution, high sugar content in food, people not getting vaccinated and climate change.

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