Executive Summary

Antibiotic Misuse – Stop Talking, Start Acting

Report from the Global Respiratory Infection Partnership
Meeting held 1st February, 2013, Royal Society of Medicine, Chandos House, London

Overall

Antibiotic resistance remains a significant global challenge.
Among healthcare professionals (HCPs), there may be lack of awareness that this is not an issue confined to hospitals but is increasingly a community care issue.
Interventions designed to reduce antibiotic prescribing can show a positive effect, even in countries with low rates.
While guidance on measures to tackle antibiotic overuse exists, further work is required to change HCPs’ behaviour in practice. This can include timely information on the professionals’ individual antibiotic prescribing rates, incentivising/making mandatory Continuing Professional Education on antibiotic stewardship and adherence to antibiotic guidelines, as well as encouraging and facilitating behavioural change among patients.

An overarching framework is needed that can be adopted across countries to create a consistent approach to change behaviour and increase knowledge in treating respiratory tract infections with or without antibiotics that provides the flexibility to meet individual country concerns.
GRIP is committed to creating such a framework that will encompass a non-antibiotic, pro-symptomatic relief policy approach to respiratory tract infections, underpinned by guidance on appropriate antibiotic use and education for prescribers, pharmacists and other HCPs together with education for patients on self-management strategies.

Factors to Consider in Managing Respiratory Infections

Antibiotic use should be reserved for patients with severe respiratory infections and for patients with increased risk for complications of RTIs: frail patients, those with pre-existing conditions or people with relevant co-morbidities.
The need for confirming bacterial infections should be re-appraised, depending on the respiratory infection. For example, many bacteria-induced sore throats do not cause serious problems.

Patients should be advised about “red flag”* symptoms that should prompt them to return for assessment.

* Red flag symptoms: This is when symptoms are not starting to settle in accordance with the expected course of the illness or symptoms significantly worsen.¹

Factors to Consider in Encouraging Behavioural Change in Patients

Patient concerns and needs should be taken seriously and treated with respect in an empathetic, understanding manner.
HCPs should work in partnership with patients to create an individualised health-management plan. Use of a personalised patient leaflet can reduce consultation time, encourage symptomatic relief and prevent unnecessary consultation.
As part of this plan, patients should be made aware of the normal duration of conditions and advised on red flag symptoms and when to re-consult.
When recommending symptomatic treatment, HCPs should identify patient preferences and recommend effective management options that match these.
Patients should be encouraged to utilise the pharmacy and non-prescription options for symptomatic relief.

Guest Speakers

Dr Laura Noonan, GP, Mullingar, Co Westmeath, Ireland
Group Captain Jungrak Phromchairak MD, Department of Otorhinolaryngology, Bhumibol Aduljadej Hospital, Royal Thai Air force, Bangkok, Thailand