GPs prescribe antibiotics patients don't want

GPs are relying too heavily on incorrect assumptions about patient needs when prescribing antibiotics, according to a Europe-wide study published today by Cardiff and the University of Antwerp.

Research shows that recovery time for patients who receive antibiotics treatment for an acute cough is equal to that of patients who receive no antibiotics at all. Yet findings reveal that all too often GPs are prescribing antibiotics based on the mistaken perception that patients want antibiotics. This has consequently led to an unnecessarily high rate of antibiotic prescribing.

Given the growing concern over the threat of antibiotic resistance - described as a "ticking time bomb" by Professor Dame Sally Davies, chief medical officer for England earlier his year - the study's findings are of particular importance in helping to identify where safe reductions in antibiotic prescribing could potentially be made.

Patients were asked if they 'expected', 'hoped for' or 'asked for' antibiotics when consulting their doctor for acute cough, as part of a study involving 3,402 patients across 13 countries. 'Expecting antibiotics' (patient's perception of what the clinician might do) differs from 'hoping for' an antibiotic prescription, and from expressing hope for an antibiotic prescription (asking for antibiotic treatment).

Understanding the influence of patient expectations, hopes and actual requests for antibiotics and clinician perception of these patient views are important in addressing inappropriate antibiotic prescribing.

Acute cough is one of the most common reasons for consulting and for prescribing antibiotics in primary care, yet the study found that the time taken for patients to get better remained largely the same, whether or not they expected, hoped for, asked for and/or received a prescription for antibiotics.

Patient satisfaction with the consultation remained high, whether or not patients actually received a prescription from their doctor. However, those who had 'hoped for' antibiotic treatment, but did not receive this, were less satisfied.

Dr Nick Francis from the School of Medicine said:

"The study provides clear evidence that patient views are not associated with illness severity, and is therefore unlikely to represent a rational reason for prescribing antibiotics. Moreover, clinicians are not good at correctly assessing patient views on use of antibiotics. We believe it is likely that satisfaction could have been increased through enhanced communication, as has been found in previous studies."

Dr Samuel Coenen from the University of Antwerp's Vaccine & Infectious Disease Institute comments:

"The results of this multicentre study provide the clearest evidence to date that patient expectations and hopes for antibiotics, and especially clinician perceptions of patient views, are independent predictors of antibiotic prescribing."

The study, published today in PLOS ONE medical journal, was part of the GRACE study 'Genomics to combat Resistance against Antibiotics in Community-acquired LRTI in Europe' funded by the European Commission.