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Thursday 23 January 2020

Doctors blamed for rise of superbugs

Half of GPs prescribe antibiotics needlessly

Caroline Crawford

FAMILY doctors are contributing to a growth in antibiotic resistant infections in some communities around the country.

A startling new Irish study has discovered that nearly half of GPs were giving inappropriate prescriptions to patients – often powerful antibiotics that may not be needed.

Liberal prescribing and a lax approach to guidelines here are significant factors in the increase of dangerous E-coli and MRSA infections that resist antibiotics, the study said.

Researchers also mapped out trends across geographic areas – and found that the odds of developing a resistant infection increased by as much as 20pc depending on the community in which you lived.

The study was led by Dr Akke Vellinga, of NUI Galway's School of Medicine, who said that Irish doctors felt under more pressure to prescribe as their patients paid around €50 a time to see them.

But she said this was fuelling the rise of dangerous new strains of bacteria – sometimes known as superbugs – which are resistant to antibiotics and extremely difficult to treat.

The World Health Organisation has warned that antibiotics, once hailed as "miracle drugs", are being overused and devalued, leading bacteria to develop their own resistance to the drugs.

The US Centre for Disease Control and Prevention in Atlanta has warned that the world has reached "the end of the antibiotics era".

Now the groundbreaking Irish research has revealed worrying trends within our general practices, where doctors are failing to follow guidelines on prescribing.

"We decided to look at it because there was nothing being done about it and we knew that there was something going on," said Dr Vellinga.

Dr Akke Vellinga: warned GPs
Dr Akke Vellinga: warned GPs

"I think we were quite surprised with how few GPs were following the guidelines."

An initial study into the following of guidelines looked at the prescribing of antibiotics for urinary tract infections (UTIs), which are the second most common bacterial infections in general practice.

It found that in 45pc of cases the treatment of uncomplicated UTI was not appropriate, with doctors failing to prescribe the correct 'first line' antibiotics which ought to be tried first.


Instead, they were prescribing 'broad spectrum' antibiotics,

The guidelines specifically say that, wherever possible, GPs should avoid prescribing 'broad spectrum'.

The term refers to an antibiotic that acts against a wide range of bugs, but ultimately may contribute to increased levels of resistance among bacteria.

Dr Vellinga said: "I think we were most surprised by the fact that while there are national guidelines available to everyone, and they are there for a reason, there are still so many GPs prescribing something that wouldn't be first line . . . and I think that was quite shocking."

The study looked initially at prescribing trends among 22 practices in the west of Ireland.

A further study discovered clusters of resistant infections in some Galway communities.

The research found that the odds of developing a resistant infection rose by as much as 20pc, depending on the community in which you lived.

It also mapped out areas where the resistance was higher and found that they often corresponded to places where nursing homes were based.

"We found with data from the lab that you were more likely to have a resistant infection if you had used antibiotics in the previous year," Dr Vellinga said.

"But there is also something else going on. There is a difference among practices, so I could theoretically go from one practice to another and change the chance I have a resistant infection.


"Most likely it is because at the practice you will meet the same kind of people, you are in the same kind of area, in a community area where people cluster together," she said.

Another NUI Galway study, by Sinead Duane, found there were often basic reasons for doctors freely prescribing antibiotics.

For example, GPs are most likely to prescribe antibiotics to patients on a Friday evening, and least likely to do so on Mondays.

It also found that GPs worried that patients felt they had got "value for money" and weren't forced to return with the same complaint days later.

The study carried out by Ms Duane, a social marketer with NUI Galway, involved in-depth interviews with 16 GPs in the Sligo area.

Irish Independent

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