I recently attended a talk presented by the newly branded Public Health England, who are currently preparing to launch their next big campaign in the fight against the ever increasing incidence of antibiotic resistance in the United Kingdom. With the impending European Antibiotic Awareness Day (November 18th FYI) I thought it would be relevant to post about it on here. There are campaigns aiming to raise the awareness across Europe, where the UK sits around middle in prescribing rates. Public health England highlight the main causes of antibiotic resistance to be;
- Overuse when not required (ie taking antibiotics for flu).
- Misuse – not completing a course or use of someone else’s leftovers.
In 1999, the “AndyBiotic” campaign was released, with the key message that antibiotics do not work on coughs and colds. The posters were displayed in GP surgeries and pharmacies, and later analysis showed 20% of people questioned in England remembered seeing the information. When questioned on the message (Are antibiotics effective against sore throats and colds?), those who hadn’t seen the information were twice as likely to be wrong (42% vs. 24%). Next, they investigated if there was an association with knowledge and correct use, but when questioned it was discovered the more educated felt empowered not to finish the course, as they believed they were making an informed decision.
The campaign was updated in 2008 with a new, modern set of posters with the same message. Analysis of this showed a remembrance rate of 14% in England, and 13% in Scotland. A seemingly satisfying result – except the campaign was never released in Scotland, putting the English results into question in addition to raising awareness of acquiescent responses – where people will tell you what they think they want to hear. Additionally, this campaign had no effect on prescription rates, so overall not a particularity effective result.
A new campaign was due to be released in early 2009 but the outbreak of H1N1 influenza changed the plans. The increase in publicity of flu meant that the public were more sensitive to acute symptoms, that otherwise would have gone unnoticed, in addition to medicalising acute illnesses so patients expected drugs when they weren’t needed. Tamiflu was distributed throughout the country without prior testing and later analysis showed only 7% of those prescribed actually had H1N1. There were also long term implications, with an increase in expectation for antibiotics.
Patients were then asked why they visited their GP. The qualitative survey found the main reasons were because symptoms interfered with everyday life, because they wanted to know what they had or because they didn’t want the symptoms to persist. The survey found 53% of patients expected antibiotics after a trip to the doctors for acute flu symptoms, and surprisingly only 3.5% were refused a prescription by their GP. 73% were given antibiotics after a discussion, which highlighted this a target for reducing antibiotic use.
Public health England have now created a so called “tool kit” for GP surgeries. Although prescription rates overall have increased 12% since 2008, a large contributor of this is thought to be down to the aging population in Britain. Targeted reductions have seen successes – for example a 128% reduction in use of cephalosporins due to a concerted effort which resulted in a significant decrease in resistance to e.coli in blood. In my opinion, they are right to be targeting the GP’s, as these are the people actually dishing out the drugs. There seems to be a culture in the UK that has developed whereby patients go to their GP’s with expectations rather to consult a professional, thus not utilizing the doctors expertise.
For more information please visit http://www.ecdc.europa.eu/en/eaad/Pages/Home.aspx