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A fair policy on antibiotic prescribing

20 August 2014 David Bennett

The threat posed by antibiotic resistance continues to feature prominently in the UK media. The recent news angle is that general practitioners stand accused of giving into patient pressure to prescribe an antibiotic even though the patient’s infection is most likely viral rather than bacterial in origin. This patient demand is considered irrational. But is it?

As a medical representative for Beecham Laboratories, the reality of local ‘policy’ at the level of individual GPs was an eye opener. In off-guard moments some GPs would confess to prescribing an antibiotic to selected classes of patient likely to be suffering a viral infection but with important occupations. This was on the basis that their condition might be caused, or complicated by, bacteria. Typical groups of professionals deemed eligible for the privilege of an antibiotic prescription included police officers, fire fighters and healthcare professionals!

For those patients with more ‘menial’ occupations, the insurance value of an antibiotic to them as an individual still holds. It’s at the societal level that such behaviour can be questioned. In this case, the conflict between the individual and the needs of the group parallels the case for maintaining herd protection through mass immunization.

Until the promise of the new Longitude Prize to develop a point of care test for bacterial infection is realized, we are left with a messy arrangement of custom and practice rather than a policy which balances the needs of individuals and society.

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