Reducing antibiotic resistance – better prescribing for less waste

It is an imperative that every possible step is made to reduce antibiotic resistance though in reality the genie is out of the bottle and, as resistance rates are already high and still rising, no significant improvements can now be expected. It’s a game of containment, to avoid making a bad situation even worse.

To achieve this, antibiotic usage must be reduced. Today we hear, not for the first time in recent months but this time to coincide with European antibiotic awareness day, the Department of Health trumpeting the message that antibiotics need not be used for trivial infections, coughs and colds etc, but reserved for use only in patients with clear signs of serious infection that would not be expected to resolve only with symptomatic care.

And as before, the onus is placed on the patient. Its your fault for demanding an antibiotic prescription. In fact, its all your fault, that we find ourselves in this situation of widespread antibiotic resistance, that you had the temerity to ask you GP for a prescription when it was not necessary.

But the issues run wider and deeper than this. Who prescribes? Who makes the decisions? It is GPs and other prescribers who have provide these unnecessary prescriptions and who are guilty of stoking the fires of antibiotic resistance. Blame cannot be placed upon the patient, for whom a simple NO together with a brief explanation of why not should suffice.

With the important and powerful lobby of GPs in particular, and with their colleagues in hospital, the pressure to improve antibiotic prescribing  will always we a wishy-washy affair until someone accepts that it is the prescriber who is at fault, and not the patient.

How does this concern us? The unwanted and unnecessary prescription may well be that which remains in the bathroom cabinet, until such time it enters the solid waste stream or is dumped into the toilet for disposal. And not only antibiotics, but every other prescription too, contaminating the environment and risking a myriad of unwanted and still largely unexplored adverse effects.

Estimates vary widely, but this may reduce the disposal of unwanted medicines by several tonnes per annum, with many more tonnes present in urine and faeces challenging our inadequate water treatment services. The impact, and potential advantages of improved prescribing, is profound.

Stop blaming the patients. It’s nonsensical. The prescriber must shoulder blame and take responsibility for more rational prescribing. To save money on drug supply costs, to avoid further resistance to antibiotics, and to reduce dramatically the vast diversity of pharmaceuticals entering the disposal chain as solid waste and in sewage.



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