Prescribing more targeted antibiotics helps to reduce risk of resistance

Staff in Swansea Bay are prescribing antibiotics in a more targeted way to help reduce the risk of antibiotic resistance and unpleasant side effects in patients.

These changes have led the health board to become the lowest prescriber in Wales for antibiotics that cover a wide range of bugs but are not specifically for one particular infection (known as broad-spectrum antibiotics).

Prescribers are working hard to achieve their aim to prescribe targeted antibiotics.

This means people will only receive the right kind to target their specific infection at the right time, minimising any potential effects that antibiotics can have.

Dr Charlotte Jones (pictured below), GP Partner at Uplands and Mumbles Surgery and the health board’s clinical lead for antimicrobial stewardship, said: “When patients present with symptoms of an infection, it’s not always clear where the infection source is – especially in children or patients who cannot communicate where symptoms are.

“So, in the past, using broad spectrum antibiotics was not unusual to cover across the common infections.”

Now, however, the more targeted approach is being encouraged.

Julie Harris, consultant antimicrobial pharmacist, added: “We are trying to minimise the use of the really broad-spectrum antibiotics because they cause more problems with antibiotic resistance and other infections.

“Antibiotic resistance is caused when bugs are exposed to antibiotics and they develop ways of overcoming their actions so they don’t work anymore.

“Even though it’s the bugs that become resistant, it does affect people because it means they have infections that are harder to treat.

“Broader-spectrum antibiotics can disrupt more of the normal helpful bacteria in the body and make this more likely to happen.”

These broader-spectrum antibiotics also come with the highest risk of causing other very unpleasant infections, such as Clostridium difficile (C. diff) infection.

It is a type of bacteria that can cause diarrhoea and often affects people who have been taking antibiotics.

C. diff bacteria usually lives harmlessly in your bowel along with lots of other types of bacteria.

But sometimes when taking antibiotics, the balance in the bowel can change, causing an infection.

Julie said: “C. diff is a bug that is normally outcompeted by the natural bacteria in the body but when that is disrupted C. diff takes the opportunity to cause an infection.

“So if we reduce our antibiotic usage, including broader-spectrum antibiotics, safely then we will reduce the number of people developing C. diff infections as a consequence of that.

“We have done a lot of work with experts in the health board to adapt our guidelines so we can avoid using broad-spectrum antibiotics wherever we can and reserve them for infections that really need them.

“This means patients will get the right antibiotic that will target their infection but minimise any other disruption to the friendly bugs in their body.”

GPs are working hard to offer the right antibiotics to the right patients at the right time.

They are doing this by identifying those with a bacterial infection, which may require antibiotics, and those with symptoms of a viral illness, which cannot be treated with antibiotics.

Viral infections can’t be treated with antibiotics because they can’t kill off viruses.

Julie (pictured) added: “The work we are doing with GP practices isn’t just to reduce the amount of antibiotics prescribed, it’s about making sure only the people who are going to benefit from them, get them.

“Antibiotics won’t benefit people with viral infections, such as sore throats, ear infections and coughs, and may actually make people feel worse through the side effects.

“GPs and other prescribers will be directing antibiotics to those patients who need antibiotics, while explaining to and reassuring those who are more likely to have a viral infection that they will get better by themselves.”

GPs have been working with the health board’s team of antimicrobial pharmacists and microbiologists, as well as experts who produce antibiotic guidelines, so they can pick the right antibiotic that will treat a specific infection.

Dr Jones said: “Having the latest guidelines readily available helps guide prescribers to know which antibiotics work best for particular infections, while also reducing the potential harmful side effects of them.

“As always, it is a balance between treating the condition and not causing new problems.

“This can be challenging when treating infections as the bugs causing them are very clever at adapting to treatments.”

Practices have also carried out audits to be able to track when broad-spectrum antibiotics have been prescribed so the team can monitor it and suggest changes where appropriate.

“It’s proven that the process we’ve used works,” Julie said.

“We’ve got prescribers engaged and they understand why this is needed and they’ve changed their practice as a result.

“It’s all about using the right antibiotic, with the least unintended consequences from it.”

Dr Anjula Mehta, Group Medical Director for Primary Care, Community and Therapies Service Group, said: “Getting antibiotic prescribing right really does prevent harm to our patients.

“I applaud the great work being done to reduce broad-spectrum and overall antibiotic prescribing across the health board and look forward to seeing this continued improvement to benefit our patients and wider population.”