‘Chemist visits’ a factor in health cost: Bartone


green and white antibiotics

AMA president Dr Tony Bartone has again called for bigger medicines pack sizes, in commenting on a move to combat antibiotic resistance

The PBAC has proposed that repeats of common antibiotics including amoxycillin, amoxycillin-clavulanic acid, cephalexin and roxithromycin should be prohibited, in a bid to support antimicrobial stewardship.

These antibiotics are those most commonly associated with repeats.

Dr Bartone told 6PR’s Steve Mills and Basil Zempilas that currently, only these antibiotics are recommended to be subject to the repeat script ban.

“Some of these bugs are very, very clever organisms, and they spread their genetic material between themselves at a rapid rate to get that defence against antibiotics,” he said.

“So the things that we’ve used in the past become useless, and the superbugs become exactly that, resistant to the effect of antibiotics, which have been lifesaving for many, many decades.

“So, we’re looking only at antibiotics in this proposal. We’re not looking at heart tablets, we’re not looking at blood pressure tablets, where repeats—and in fact, in those areas, we do want larger quantities to be prescribed where the patient is stable and under the care of their GP. It makes sense that you don’t have to go back again and again to get just the repeat prescription.”

Dr Bartone cautioned listeners that they should not need more than one pack size to treat an illness requiring these antibiotics, and not to keep leftover or repeat antibiotics “for a rainy day” as this was to unnecessarily overuse them.

When Mr Zempilas asked him whether patients should pay GPs a full consultation fee for a script with repeats, Mr Bartone said that “the next time you see your GP is usually dictated by the clinical need to be seen, and the doctor will, more often than not, if not always, give you enough medication to last you till that next visit”.

“So, the next visit shouldn’t be decided by when you need to have your next repeat, it should be driven by your next clinical review.

“So, if six months is the appropriate time to be reviewed for your blood pressure, you should get the six months’ worth of medication—the first script plus the five repeats.

“But what we’re saying is when you’re stable, well you know what, why do you need five repeats? Why can’t you have a double pack size which the PBAC have already recommended, and only have three repeats?

“So you’re even going less to the chemist. That’s where a lot of the cost is also driven. So the cost of seeing your GP should be about getting that care and the review required to manage your condition.”

On the subject of antimicrobial resistance, Dr Bartone warned that “we just need one more or two more superbug changes and we’ve potentially got something that we can’t treat” as new antibiotics are so far down the research pipeline.

Dr Mina Bakhit, Postdoctoral Research Fellow at the Institute for Evidence-Based Healthcare (IEBH) at Bond University, also weighed in on the PBAC recommendations, saying that the move is important because GPs tend to prescribe antibiotics for certain conditions – such as acute cough, middle ear infection and sore throat – for very little or no benefit.

“With acute respiratory tract infections, the benefit of using antibiotics would be a saving of around 12 hours over the duration of the whole infection,” she said.

“For example, if a child with acute otitis media takes antibiotics, their earache will on average resolve in three days. If a child does not take antibiotics, their earache will resolve in 3.5 days

“There are of course the harms of using antibiotics (like vomiting, diarrhea or rash), and the problem of antibiotic resistance itself.

“Antibiotics should not be prescribed as the first line of treatment for the majority of these infections as these are treated symptomatically by over-the-counter medications.”

She warned of two problems with repeats for antibiotics.

“The first is, patients who have repeat prescriptions have the tendency to get the second course and keep it in their home. Or they believe they need to repeat the prescription and that they can use it whenever they want.

“This poses an issue with antibiotic resistance and the same antibiotic is not going to be as effective the next time they use it.  

“The second thing is, antibiotics should not be used lightly. We need to save these treatments for when they are actually needed.

“With the increased risk of antibiotic resistance both within the individual and the community, I think it’s a very good step to ban repeat prescriptions. Antibiotics must be prescribed only when absolutely necessary.”

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