Pharmacists should support patients with delayed antibiotic prescriptions

Antibiotic resistance has been well documented recently as one of the most significant challenges to future public health in the UK and beyond.

The clinical guideline from the National Institute for Health and Care Excellence[1]
 recommends the use of delayed prescription strategies to help reduce antibiotic prescribing in the community. Delayed antibiotic strategies describe situations when a prescription is made available to or is intended for use by a patient after a specified period following a consultation with the prescriber. The prescriber can forward date the prescription so that it is not legal to dispense it until the valid date is reached. Alternatively, a legally dated prescription can be retained in the surgery for collection by the patient if his or her symptoms do not improve, or a legally dated prescription, annotated as “delayed”, is issued to the patient with instructions not to collect the antibiotics unless no improvement in symptoms is seen within a specified period.

Since the publication of the NICE clinical guideline, a 2013 Cochrane review[2]
 concluded that “most clinical outcomes show no difference between strategies. Delay strategies slightly reduce patient satisfaction compared to immediate antibiotics (87% versus 92%) but not compared to none (87% versus 83%). In patients with respiratory infections where clinicians feel it is safe not to prescribe antibiotics immediately, no antibiotics with advice to return if symptoms do not resolve is likely to result in the least antibiotic use, while maintaining similar patient satisfaction and clinical outcomes to delayed antibiotics.”

However, the findings of a recent BMJ article[3]
 found 55% of GPs felt under pressure — mainly from patients — to prescribe antibiotics, even if they were not sure that they were necessary, and 44% admitted that they had prescribed antibiotics to get a patient to leave the surgery.

As such, a more pragmatic approach would be to continue to offer delayed prescriptions to patients and appropriate support materials for patients because this may be more palatable to prescribers given the findings of Torgesen’s survey.

Pharmacy as a profession has an important role in delayed prescribing strategies to support the reduction in antibiotic use in primary care by working with individual patients when presented with a delayed prescription.

I would encourage all pharmacists to investigate whether delayed prescription strategies are being considered in their local area and offer their support.

 

Graeme Bryson

Ayrshire & Arran

References

[1] Guidance from the National Institute for Health and Care Excellence. Respiratory tract infections – antibiotic prescribing: Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care. Available from:  http://www.nice.org.uk/guidance/cg69

[2] Spurling GK, Del Mar CB, Dooley L, et al. Delayed antibiotics for respiratory infections. Cochrane Database of Systematic Reviews. 2013 Apr;30(4):CD004417

[3] Torjesen I. UK spearheads efforts to combat rising threat of antibiotic resistance. BMJ 2014;349:g4418

Last updated
Citation
The Pharmaceutical Journal, PJ, 13 September 2014, Vol 293, No 7827;293(7827):DOI:10.1211/PJ.2014.20066345