Surgeries employing GPs with additional training in complementary medicine appear less likely to prescribe antibiotics

Use of
complementary/alternative medicine may help reduce over prescribing of
antibiotics, a new study has found.

GP surgeries with doctors
who also have training in complementary and alternative medicines appear to be
less likely to prescribe antibiotics to patients and may hold the key to
reducing over-prescribing of these drugs, suggests the study led by University of
Bristol researchers published in the journal BMJ Open.

Inappropriate and over-use
of antibiotics leading to antimicrobial resistance are growing problems for
international public health, but reductions in antibiotic use have been shown
to be associated with a reduction in some resistance.

In the UK, 74 per cent of
antibiotics are prescribed in primary care making it one of the most important
contributors to this development.

GPs vary in their
prescribing behaviour due to various factors including different views on
medicalisation, different guidelines between countries, and use of
complementary and alternative medicine (CAM) integrated in their daily
practice, also known as integrative medicine (IM).

So far, any association
between the knowledge and use of IM by GPs and antibiotic prescribing has not
been widely scrutinised.

UK, German and Dutch
researchers led by the University of Bristol, therefore, set out to examine what
differences there may be in antibiotic prescription rates between conventional
GP surgeries and those with GPs who had also been trained in integrative
medicine using NHS Digital monthly prescribing data for 2016.

Data from 7,274 GP surgeries
was studied and compared with nine practices that had GPs who had training in
integrative medicine, looking at overall prescribing of antibiotics, as well as
prescribing of these drugs for respiratory tract infections and for urinary
tract infections.

Analysis showed that
practices that employed GPs with additional training in IM had significantly
lower antibiotic prescribing rates than those with conventional GPs.

Prescribing of antibiotics
for patients with respiratory tract infections was also noticeably less in
practices with IM-knowledgeable GPs.

However, there was no
difference between the two types of practice when it came to levels of
antibiotic prescribing to patients with urinary tract infections.

The authors acknowledged
that their results were limited by the lack of data on number of consultations,
individual GP characteristics, individual deprivation scores and continuum of
care.

In addition, the pool of
practices with GPs trained in IM was small because accessibility of IM/CAM
within the NHS in general practice in England is very limited and IM/CAM
provision is currently almost exclusively private in the UK.

Nevertheless, the authors
said that the difference seen in antibiotic prescribing rates at practices with
GPs trained in IM warranted further study.

The lower antibiotic
prescription rates of practices with GPs trained in IM were in line with
current national guidance aimed at reducing antibiotic usage and antimicrobial
resistance, they said.

They argued, therefore, that
these practices might be more compliant with this guidance, but the differences
found might also be due to other possibilities such as:

• patients who consulted
  practices with GPs trained in IM were less keen on getting antibiotics
• practices with GPs trained in
  IM had other avenues to offer to patients than antibiotics.

The authors said:

“For the
majority of respiratory tract infections, it is recommended that antibiotics
should be avoided or delayed, so that this is an area where the desired
reduction in prescribing could take place.”

They concluded:

“Additional
treatment strategies for common primary care infections used by practices with
GPs trained in IM should be explored to see if they could be used to assist in
the fight against antimicrobial resistance.”