Experts call for antibiotic prescribing practices to be standardised across Europe

EU-funded researchers have identified wide variations in the way antibiotics are prescribed across Europe. In some countries, just 20% of patients who go to their doctor with a cough are give antibiotics, while in other countries this figure is close to 90%. Furthermore, results from the study showed that taking antibiotics appeared to have little effect on patients' recovery times.

Writing in the British Medical Journal (BMJ), the scientists call for antibiotic prescribing practices to be standardised across Europe, as part of efforts to tackle the problem of antibiotic resistance.

EU support for the work came from the GRACE ('Genomics to combat resistance against antibiotics in community-acquired lower respiratory tract infections in Europe') project, which is financed under the 'Life sciences, genomics and biotechnology for health' Thematic Area of the Sixth Framework Programme (FP6).

"This threat of antibiotic resistance is likely to be more acute as GPs [general practitioners] face increasing demands to prescribe antibiotics for acute cough amidst the current global H1N1 flu pandemic," stated GRACE project coordinator Herman Goossens of the University of Antwerp in Belgium. "This new evidence should prove instrumental in containing antibiotic prescribing."

Antibiotic resistance is a major problem for health systems worldwide; in 2006, 39% of invasive bacteria in Europe were resistant to penicillin. Unnecessary antibiotic prescription, especially for respiratory problems such as coughs, is often blamed for the rise in drug-resistant bugs.

Providing antibiotics when they are not needed also wastes resources, puts patients at risk of side effects and increases the likelihood that patients will visit the doctor when they have similar symptoms in the future (instead of taking better care of themselves).

In this study, researchers tracked the experiences of 3,402 patients who went to their doctors with a new or worsening cough or a possible infection of the lower respiratory tract. The patients were recruited to the study from 14 primary care research networks across Europe.

Each patient's medical history, including antibiotic prescriptions, was recorded, along with the severity of their symptoms. Patients were also asked to rate and record their symptoms in a diary for 28 days.

Overall, some 53% of patients were prescribed antibiotics, but there was tremendous variation between countries. Less than one third of patients in Belgium, Norway and Spain were prescribed antibiotics. In contrast, in Italy, Hungary, Poland and the UK, well over two thirds of patients were offered antibiotics. Slovakia topped the prescription league: 87.6% of patients in its capital Bratislava were prescribed antibiotics.

Differences between the severity and duration of patients' symptoms, smoking habits, age, temperature and other health problems could not account for these differences in antibiotic prescription habits.

Furthermore, the patients' symptom diaries revealed that the drugs did not have a significant impact on patient recovery times.

The researchers also identified differences in the types of antibiotics prescribed: for example, amoxicillin, the most common antibiotic prescribed in the study, accounted for just 3% of prescriptions in Tromsø (Norway) but for 83% of prescriptions in Southampton (UK). The authors of the paper suspect that these differences could be due to different guidelines and habits in different countries. They will investigate this issue further in another study.

"This international collaborative research showed that the big differences in antibiotic prescribing between countries are not justified on clinical grounds," commented the paper's lead author, Professor Chris Butler of Cardiff University in the UK. "It therefore identifies a major opportunity for greater standardisation of care across Europe."

For further information, please visit:

  • British Medical Journal (BMJ),
  • GRACE project,

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