Test could reduce need for antibiotics

 

A simple three-minute test could cut the rate of unnecessary prescribing of antibiotics by 65 per cent, the WONCA medical conference has been told.

A survey presented at the conference showed many GPs mistakenly prescribed antibiotics which were of no use for the type of infection being suffered by the patient. Dr Michael Coughlan, outgoing chairman of the Irish College of General Practitioners, said the test, which involved pricking the patient's finger to take some blood, indicated within three minutes if the infection was bacterial and needed an antibiotic.

He said the trend toward antibiotic resistance and the cost of drugs should encourage doctors and patients towards increasing use of this test.

As part of the study three doctors clinically assessed 80 patients with upper respiratory tract infection - sore throat, tonsilitis, ear infection - through questioning and examination. If they felt it appropriate, they prescribed an antibiotic.

These types of illnesses are the leading cause of visits to the doctor in developed countries and the major cause of absenteeism. In the US, adults suffer an average of two to four colds a year and children six to eight. Dr Coughlan said there was no evidence that treating upper respiratory tract infections prevented pneumonia or shortened the infection.

Following consultation with a doctor, a nurse carried out the test, and compared the result with the GP's analysis. The doctors had decided that 41 of 73 patients had bacterial infections and needed an antibiotic, but the test showed only 15 patients needed one.

Dr Coughlan said patients often expected or demanded an antibiotic. "They say `Doctor, I have a wedding tomorrow' or `I'm going on holidays at the weekend'. The decision can be influenced by a patient's expectation," he said.

Doctors deciding not to prescribe antibiotics would need to spend more time explaining the decision and warning patients about which signs or symptoms would require further consultation. The challenge was in improving the diagnosis of viral infections and so reducing inappropriate prescribing of antibiotics.

Dr Coughlan said the increasing trends in antibiotic resistance meant that such a test - which costs an average of £3 - should be introduced in all surgeries.

"In the long term, it would be of benefit to everyone. Patients unwilling to have their immune system unnecessarily compromised might be willing to pay or a doctor might include it in the consultation fee," he said, adding that it should be included on medical card entitlements since the test would save money on drug costs.