24 July 2008

Limiting prescriptions - can it be done, will it help?

I'm on the road reporting for two weeks, which makes keeping up with MRSA news fairly challenging. (Hangs head in shame, promises to do better in August when I will be chaining myself to my computer in vain hope of meeting a manuscript deadline.)

Meanwhile, here is a tidbit of news on the MRSA front, from the UK. As our international readers will know (oh yes, we have them, Google Analytics makes a very nice map - hi, London! say hello, Rotherham!), MRSA has been a ferocious hospital pathogen in the UK, but community strains have been less problematic there until recently.

The National Institute for Health and Clinical Excellence, an agency that does cost-benefit analysis on behalf of the National Health System, has asked doctors to limit prescribing antibiotics for most of the upper-respiratory infections they see in private practice on the assumption that most URIs will be viral and therefore not helped by antibiotics anyway.
...Doctors in the state's health system should not prescribe antibiotics for most cases of sore throats, colds, bronchitis or other types of respiratory infections, the National Institute for Health and Clinical Excellence, or NICE, said.
They should also delay writing such prescriptions and reassure people the drugs are not needed immediately and would make little difference because most respiratory infections are viral, the new guidelines said. ...
The drugs watchdog said a quarter of people in England and Wales visit the doctor because of respiratory tract infections, which account for 60 percent of all antibiotic prescriptions in general practice. (Reuters, byline Michael Kahn)
Note that this is a guideline, which is to say voluntary — though because it is promulgated by a regulatory body within a single-payer health system, may well have more force than similar guidelines that have been promulgated in the US by professional societies such as the Infectious Diseases Society of America. This article from IDSA from last April captures how effective guidelines have been here. Answer: Overall, not much, because they are a matter of asking, not compelling.

I'm interested in hearing from any readers who have experience with antibiotic stewardship programs at the society level or in institutions: Do they work, what does it take to implement them, how draconian do you have to be? If anyone can offer thoughts, please comment or send me a private email to the address in the right-hand column.

On to North Carolina.

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