Scientists warn drug being 'inappropriately' prescribed could lead to 'biggest threat to global health'

At the same time, older people who may not be able to deal with infections without antibiotics are not receiving them as much - meaning they could face more complications or hospital admissions

Doctors are prescribing antibiotics for tens of thousands of patients with infections, with 'little or no consideration of prognosis and the risk of the infection worsening', according to a new study led by University of Manchester scientists.

Many younger people are being prescribed antibiotics, even though they are often fit enough to recover from their condition without them. That could lead to antibiotic resistance, 'the biggest threat to global health, according to the researchers.

Meanwhile, older people who may not be able to deal with infections without antibiotics are not receiving them as much. That could mean they face more complications to their health or deteriorate to the point of needing to be admitted to hospital, the epidemiologists found.

The University of Manchester's Professor Tjeerd van Staa, one of the leaders of the study, said: “Antibiotics are effective in treating bacterial infections, but they carry the risks of antimicrobial resistance (AMR) and loss of effectiveness when used inappropriately.

“That is why AMR to antibiotics has been recognised as one of the biggest threats to global public health.

“Given the threat of resistance, there is a need to better target antibiotics in primary care to patients with higher risks of infection-related complications such as sepsis.

“But this study finds that antibiotics for common infections are commonly not prescribed according to complication risk and that suggests there is plenty of scope to do more on reducing antibiotic prescribing.”

The study of 15.7 million patient records, funded by the National Institute for Health and Care Research and published in the Journal of the Royal Society of Medicine earlier this month, suggests far fewer antibiotics could be prescribed.

The researchers found the probability of being prescribed antibiotics for a lower respiratory tract or urinary tract infection was unrelated to any risk of hospital admission.

And the probability of being prescribed an antibiotic for an upper respiratory tract infection was only weakly related to the patient's risk of being admitted to hospital.

The study also showed that patient characteristics such as age and the presence of other health problems were only weakly associated with the probability of being prescribed an antibiotic treatment of common infection.

The most elderly patients in the sample were 31 per cent less likely than the youngest patients to receive an antibiotic for upper respiratory infections.

That means that because many younger people are being prescribed antibiotics, even though they are often fit enough to recover without them. That could lead to antibiotic resistance, say the researchers.

Conversely, many older people who may not be able to deal with infections without antibiotics are not receiving them, with the potential of complication and hospital admissions.

Patients with combinations of diseases were seven per cent less likely than people without major health problems to receive an antibiotic for upper respiratory infections, said the scientists.

The study also showed that the probability of being prescribed an antibiotic for lower respiratory infections was even more unrelated to complication risk during the pandemic, however they were only minor changes for urinary tract infections.

The lead authors of the study are Professor Tjeerd van Staa and Dr Ali Fahmi, from The University of Manchester.

The research team used anonymised patient-level electronic health records of primary care data from The Phoenix Partnership through OpenSAFELY, a secure platform for electronic health records in the NHS.

They included adults registered at general practices in England from January 2019 to March 2023 diagnosed with upper respiratory, lower respiratory and urinary tract infections.

Risks to each patient of hospital admissions related to infections were estimated for each infection using risk prediction scores for patients who were not prescribed an antibiotic.

Dr Ali Fahmi added: “Rather than imposing targets for reducing inappropriate prescribing, we argue that it is far more viable for clinicians to focus on improving risk-based antibiotic prescribing for infections that are less severe and typically self-limiting.

“Prognosis and harm should explicitly be considered in treatment guidelines, alongside better personalised information for clinicians and patients to support shared decision making.”

“A Knowledge Support System led by Professor Tjeerd van Staa, which provides personalised information to clinicians is now being tested in north west England.

“We hope it could provide a workable solution to the problem of untargeted antibiotic prescribing.”