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High prescribing rate during Covid might be linked to ‘inappropriate antibiotic use’ in remote consultations, experts suggest


By Isabel Shaw
Reporter

08 Dec 2020

The ‘unexpectedly’ high rate of prescribing during Covid-19 could be linked to ‘inappropriate’ antibiotic use in telephone consultations, two healthcare experts have suggested.

In an article published on The Lancet, the two Nottingham University researchers compared NHS general practice data and concluded that it supported existing evidence that antibiotic prescribing rates are higher in remote consultations than those carried out in-person.

The data showed that between April 1 and August 31, there was a 51% decrease in face-to-face appointments compared with the same period in 2019, while the number of telephone appointments increased by 170% and the overall number of appointments decreased by 20%.

The number of antibiotic prescriptions made by GPs over the same period in 2020 was 15% lower than in 2019 – but given the decrease in the absolute number of appointments, this number of prescriptions was 6.7% higher than expected, the researchers found.

The report said: ‘The decrease in absolute number of antibiotic prescriptions reflects the trend of falling antibiotic consumption in general practice since 2014, and the aim to reduce prescribing. However, the unexpectedly high rate of prescribing during Covid-19 might reflect additional instances of inappropriate antibiotic use in telephone consultations.’

Antimicrobial resistance

The report – by Richard Armitage, a GP, and Laura Nellums, assistant professor of global health at Nottingham University – said the data supported existing evidence that antibiotic prescribing rates are higher during remote consultations than face-to-face appointments.

‘This increase could reflect the greater diagnostic uncertainty that results from an inability to examine patients and perform investigations during telephone appointments, which might lead clinicians to take greater precautions in cases of possible infection,’ it said.

The researchers also suggested that the data reflected existing concerns that Covid-19 might be contributing to antimicrobial resistance.

‘With evidence that 70% of patients with Covid-19 receive antibiotics when not clinically indicated, the focus has centred on antibiotic misuse in the clinical management of COVID-19, but not on the additional risks posed by remote prescribing,’ they said.

The researchers concluded that while the rates of telephone appointments in general practice remain ‘unusually high’, GPs must be supported to prescribe antibiotics ‘appropriately’.

‘Such stewardship, alongside continuity of essential care and availability of rapid diagnostics, is vital to curb the emergence of antimicrobial resistance, one of the largest threats to global public health,’ they added.

‘Incredibly important issue’

Commenting on the report, Jacqueline Sneddon, chair of the Royal Pharmaceutical Society Antimicrobial Expert Advisory Group, said fewer patients are seeking appointments for common minor ailments, which is likely to have ‘reduced unnecessary prescribing of antibiotics for these conditions’.

‘Lockdown measures as a means of controlling coronavirus have reduced the spread of other common respiratory infections,’ she said.

‘However, lockdown restrictions have led to a decrease in face-to-face interactions with healthcare professionals and data suggests an increased rate of antibiotic prescribing via remote consultations out of precaution.’

She added that antimicrobial resistance is an ‘incredibly important issue’ driven by antibiotic use and it is vital that people understand that antibiotics should not be used to treat viral infections such as colds, flu and coronavirus.

‘Pharmacists have an important role to play in educating patients on how to manage symptoms of common infections and can provide advice on when they should consult their GP,’ she said.


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