THERE HAS been a sharp increase in antibiotic prescribing for medical card patients, new research has found. One of the antibiotic groups has strong links to the development of MRSA and clostridium difficile in hospitals.
The findings are expected to influence forthcoming recommendations aimed at achieving €64 million in drug savings as part of the deal to provide medical cards to 95 per cent of people over 70.
The research, published yesterday, identified a 25 per cent increase in antibiotic prescribing for medical card patients between 2000 and 2005.
Dr Bernadette McGowan and colleagues at the National Centre for Pharmacoeconomics and the Department of Pharmacology and Therapeutics at St James's Hospital, Dublin examined the prescribing of antibiotics by GPs in the General Medical Service (GMS) scheme.
All prescription data for oral antibiotics used to treat infections involving the respiratory, urinary and other systems was analysed to identify prescribing trends.
The results, published in the current issue of the Irish Medical Journal, show the prescribing of certain antibiotics has risen sharply. Doxycycline use increased by 95 per cent, while the use of flucloxacillin, a drug primarily used for soft tissue infections, rose by 42 per cent. Of particular concern was the doubling of prescribing of the quinolone group of antibiotics.
A number of studies have identified a link between quinolone use and the subsequent development of healthcare-acquired infections such as clostridium difficile and MRSA. The most commonly prescribed quinolone was the drug ciprofloxacin.
According to the authors, some 80 per cent of antibiotics are used to treat respiratory tract infections. They say that up to 50 per cent of antimicrobial prescribing in humans may be inappropriate.
A number of reports have concluded that the prescribing of antibiotics for the treatment of sore throats, sinusitis, acute bronchitis and middle ear infection has a minimal effect. But patient expectation and pressure also contribute to inappropriate antibiotic prescribing.
Acknowledging the research would influence the deliberations of the group set up by Minister for Health, Mary Harney, to achieve drug savings of €64 million as part of the deal to extend medical card eligibility to a greater number of over-70s following the Budget climbdown, the group's chairman, Dr Michael Barry, director of the National Centre for Pharmacoeconomics, last night told The Irish Times, "we will be looking at a wide range of therapeutic areas in our assessment of prescribing across community drug schemes".
The latest research has identified a marked seasonal variation in antibiotic consumption over the six-year period. Prescriptions for penicillins and cephalosporins fell by 35 per cent between January and August, but increased again from August to December.
"Seasonal variation in antibiotic consumption is most likely related to increased prescribing for respiratory tract infections in the winter months," the authors said.
Antibiotic consumption varies across Europe. Many countries including Greece, Croatia, Ireland and Portugal show a year-on-year increase while others including France, the Czech Republic and Sweden achieved some reduction. Both Belgium and France have shown a sustained decrease since 2001.