Growing concern over the use of “drugs of last resort” in Scottish hospitals

Prescriptions of antibiootics are on the rise despite Scottish Government attempts to drive down their supply

The use of antibiotics in Scottish hospitals is on the rise with concerns raised over the increased supply of the “drugs of last resort” to patients.

Health Protection Scotland found that prescriptions for hospital patients increased by 5.9 per cent last year - with an rise of 455,000 daily doses recorded.

HPS said it was a “particular and growing public health concern” that a 2.1 per cent increase in the use of carbapenems had been found.

Carbapenems are a group of powerful antibiotics used to treat certain conditions but of which there is no known alternative should a patient become resistant to them.

A report by Health Protection said carbapenems may be regarded as the “drugs of last resort”.

It added: “This is a particular and growing public health concern as there are limited treatment options for infections caused by these bacteria once they become resistant to carbapenems.”

The rise comes despite guidance from Scottish Antimicrobial Prescribing Group (SAPG) on alternatives to carbapenems, which are usually used in the treatment of abdominal infections, complicated urinary tract infections and pneumonia.

A study is now underway by the University of Strathclyde to find out why the guidance is not being followed in hospitals.

Meanwhile, HPS found that GPs in Scotland have cut back on prescribing antibiotics to such an extent that levels are back at 2005 rates.

However, still 30 per cent of Scots received at least on anti-bacterial from their GP last year.

Professor Dilip Nathwani, Chair of SAPG, said he was pleased progress had been made amongst GPs to bring down the use of antibiotiocs in Scotland.

He added: “However use of antibiotics in hospital has increased and so there is still further work to be done in reducing inappropriate use of this vital group of medicines to keep resistance rates as low as possible and to tackle Clostridium difficile infections.

“SAPG will continue to work closely with prescribers, health and care staff, patients and the public to improve antibiotic use across all care settings across Scotland”.

The findings come after the Scottish Government announced last year it was “leading the way” on tackling antimicrobial resistance with the publication of a revised action plan.

Professor Hugh Pennington, emeritus professor of bacteriology at Aberdeen University, said the rise in hospital prescriptions now recorded could be down to the high number of older patients in hospital and steady rates of pneumonia amongst them.

“HPS are right to raise this important issue. One of the big things about trying to restrict antibiotic use is that if you don’t, you have more resistance and you run out of antibiotics.

“That is something you want to avoid and the best way to do that is slow down use and keep it under reasonable control. We must use antibiotics with care. They are too good to waste.”

Professor Pennington said good communication was required between consultants, hospital pharmacies a microbiology labs to insure appropriate use.

“That has been an issue for years.

“You have to assume that, generally speaking, what is being given to the patient is what the doctor thinks is in the patient’s best interest but if there is an alternative or they are not paying attention to lab results, then improvement has to be made.”

Health Secretary Shona Robison said the Scottish Government had been “working hard” to tackle the “global health threat” of resistance to antibiotics.

She said: “Prudent prescribing and active stewardship of antibiotics has a major role to play in achieving this and significant progress has been made.

“Since 2007, we have achieved significant reductions in Healthcare Associated Infections. Latest figures show that cases of MRSA have reduced by 88 per cent and cases of C.diff in patients aged 65 and over have reduced by 84 per cent and these reductions are in part due to improved use of antibiotics in both hospital and community settings.”

“Evaluation is being undertaken around Rapid Molecular Diagnostics and quicker clinical turnaround times for test results – with recommendations that such technology be made available to quickly identify multi drug resistant organisms such as Carbapenemase-Producing Enterobacteriaceae and allow for improvements in areas such as patient management and more targeted antibiotic use.”