GPs prescribing outdated antibiotics for gonorrhoea

GPs prescribing outdated antibiotics for gonorrhoea

A significant number of prescriptions for no longer recommended antibiotics to treat gonorrhoea are still being issued by GPs, claims a study* published today in the online journal BMJ Open.

UK researchers found that some GPs were failing to keep abreast of clinical guidance and risked contributing to antibiotic resistance by continuing to prescribe outdated antibiotics.

Chlamydia and gonorrhoea are the two most commonly diagnosed bacterial sexually transmitted infections (STIs) in the UK, with 237,675 and 28,594 diagnoses, respectively, reported in 2012.

There are ongoing concerns about the effectiveness of antibiotics to fight many infectious diseases because of inappropriate use and overuse, but gonorrhoea has become a particular worry because the bacterium that causes it, Neisseria gonorrhoeae, has developed resistance to the antibiotic ciprofloxacin.

Researchers led by Public Health England set out to determine the contribution of general practices to the diagnosis of Chlamydia and gonorrhoea in England and whether treatment complied with national guidelines.

They analysed electronic health records entered anonymously into the Clinical Practice Research Datalink – a database containing the health records of around 5.5 million patients registered with 680 UK general practices – as well as information from anonymous monitoring of STIs in England. The researchers looked particularly at how doctors in general practice had treated Chlamydia and gonorrhoea between 2000 and 2011.

Results showed that GPs diagnosed an estimated 193,000 people with Chlamydia and nearly 17,000 with gonorrhoea during this period, accounting for between 9% and 16% of all Chlamydia cases and between 6% and 9% of all gonorrhoea cases in England. Numbers of diagnoses GPs made for Chlamydia rose from 22.8 per 100,000 of the population in 2000 to 29.3 per 100,000 of the population in 2011.

Most (90%) patients were prescribed an antibiotic recommended in national clinical guidance, but this was not the case for gonorrhoea. Despite being discontinued as a recommended treatment for the infection in 2005, ciprofloxacin continued to be prescribed and accounted for more than four out of 10 prescriptions (42%) in 2007, and still 20% of prescriptions in 2011.

Existing evidence from other research shows that more than a third of gonorrhoea infections treated at sexual health clinics were resistant to ciprofloxacin, for example, while up to one in five cases may be resistant to penicillin. The researchers concluded that GPs made an important contribution to the diagnosis and treatment of bacterial STIs, but while most patients with Chlamydia were treated appropriately, “significant numbers” of those infected with gonorrhoea were not.

They said: “Treatment of infections with reduced susceptibility or resistance to the prescribed therapy may inadvertently facilitate onward transmission and risks infection complications.” 

GPs could be less aware of gonorrhoea treatment guideline revisions due to the relative infrequency of cases seen, they said, but added: “Practitioners should be alert to the likelihood of revisions to national treatment guidelines and of treatment failure in their patients.”

By Adrian O'Dowd,

OnMedica, Friday 29 May 2015

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