Offering financial incentives to NHS commissioners reduces the amount of antibiotics in the community and could help to curb drug-resistant infections.

The findings come from a paper, published today in the Journal of Antimicrobial Chemotherapy, which shows the number of patients prescribed antibiotics by their GP for a common respiratory infection decreased significantly following the introduction of a national incentive scheme for the NHS.

According to the team at Imperial College London and Public Health England, this is the first study to assess the impact of such a scheme and shows that financial rewards helped to reduce antibiotic prescriptions for common respiratory tract infections (RTIs) by 3%, particularly among children.

The research was supported by the National Institute for Health Research.

The study team say the approach could help to tackle excessive use of antibiotics in the community. The use of antibiotics in cases where they may offer only limited clinical benefit is a key driver in the rise of drug-resistant bacteria. If these resistant bacteria cause severe infections, antibiotics may no longer work when they are needed.

In England, RTIs, which include coughs and sore throats, are one of the most common reasons for a visit to the GP, and GP clinics the most common setting where doctors prescribe antibiotics. However, many mild RTIs may clear up without treatment, and the majority are caused by viruses, in which case antibiotics are ineffective as they only work against bacteria.

GPs are currently unable to identify whether an infection is caused by a bacteria or virus, explained Sabine Bou-Antoun, an epidemiologist and research postgraduate at the School of Public Health at Imperial and first author of the study: “In clinic, GPs have a short amount of time in which to see a patient, make a diagnosis, and recommend a treatment where required.”

“For respiratory infections, this is complicated further by unspecific symptoms and lack of a ‘point-of-care’ diagnostic tool to distinguish between a bacterial and viral respiratory infection. This clinical uncertainty, along with patient anxiety regarding their infection, or their child’s, may influence the decision to prescribe antibiotics.”

"We do, however, know that RTIs are commonly viral and that they are likely to resolve without antibiotic treatment, and so antibiotics are likely to offer little benefit to these patients.”

Financial incentives

As part of a wider approach to reduce the growth of antimicrobial resistance (where overuse of antibiotics is driving drug-resistant infections, making antibiotics less effective), the NHS is trying to reduce antibiotic prescriptions in the community with schemes that include financial incentives for commissioners.

In this study, the team reviewed data from general practices across England, focusing on prescribing of antibiotics for uncomplicated RTIs from 2011 to 2017.

Their analysis revealed that aside from the expected seasonal peaks and troughs associated with winter and summer periods, prescribing rates fell by 3%, or 14.65 prescriptions per 1,000 RTIs, in April 2015—coinciding with the introduction of the incentive scheme around antibiotic prescribing.

The analysis also showed reductions in the rate of prescriptions for broad-spectrum antibiotics for RTIs.

They found that the greatest reductions in antibiotic prescribing were seen for patients with sore throats, as well as in younger patients, with a 6% reduction in prescribing for children. The researchers explain that rates of GP visits for RTIs are higher in children as they are more likely to pick up coughs and colds, and anxious parents are more likely to take them to the doctor.

According to the group, further research is currently being undertaken to follow up on the findings to establish whether reductions in antibiotic prescribing in primary care is associated with any negative impacts, including increased illness.