Paying Medical Organizations To Prescribe More Carefully Delays Antibiotic Resistance

Financial incentives could slightly reduce the number of drugs that are being inappropriately prescribed. Bukhta Yurii/Shutterstock

Health authorities around the world are increasingly worrying about the rise of antibiotic-resistant bacteria, something that will kill tens of millions if we don't act fast. The British National Health Service (NHS) has been trying the approach of paying the regional bodies that provide health services more if they stop prescribing drugs unnecessarily, and the good news is, it works. Unfortunately, the effect is far too small to stop the problem entirely, but it could be one part of a suite of responses that collectively save our medicines.

Bacteria are evolving resistance to existing antibiotics for many reasons, but over-prescription is a big one. Many people who go to the doctor with conditions that won't benefit from antibiotics walk away with a prescription for them anyway. Every time someone takes antibiotics it gives an advantage to any bacteria in their system, harmful or not, with a resistance to the drug. Considering the multiple paths via which genes can be transferred between bacterial species, this resistance can quickly turn up in deadly bacteria, even if they evolved in harmless species.

Health authorities have long recognized part of the answer has to be persuading doctors to stop over-prescribing. But that's easier said than done. Economists have argued for financial incentives, and in 2015 the NHS decided to try them out. The Clinical Commissioning Groups responsible for delivering NHS services in a region receive extra money if there is a decrease of more than 1 percent in prescriptions by the doctors they cover.

The first assessment of this program has been published in the Journal of Antimicrobial Chemotherapy, revealing a small but significant success.

Imperial College London postgraduate student Sabine Bou-Antoun and co-authors looked at the rate of antibiotic prescription for respiratory tract infections (RTIs), the most common reason for visiting a doctor, between April 2011 and March 2017. They found a 3 percent fall in prescriptions for RTIs occurring when the incentives were introduced in April 2015. Even better, this drop has been sustained, and has even doubled when it comes to prescriptions for children.

Most RTIs are caused by viruses, so antibiotics are only of use for the minority with bacterial secondary infections. Unfortunately, many patients don't understand this, and reject advice for rest, fluids, and painkillers, instead insisting on getting drugs. The placebo effect sometimes means these antibiotics do help, but no more than sugar pills would.

In addition to the problem of stimulating resistance, this over-prescription can kill beneficial bacteria in the gut or other places, with associated negative consequences.

Any reduction in RTI antibiotic prescriptions is useful, particularly when the UK's rate is well above some other European countries, but we'll certainly need to do better than 3 percent if we want these drugs to be useful in decades to come.

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