Antibiotics, adherence and long-term condition management

November 18th, 2016 by Alistair Murray

Today is European Antibiotic Awareness Day, and the consensus is that we need to stop over-prescribing.

Antibiotic resistance, a consequence of over-prescribing, is such a threat that the UN cites it as one of the biggest risks to global health. In short, if we can’t use effective antibiotics to treat infections there is a risk of more deaths from previously treatable infections, a massive increase in costs to healthcare systems.


This is an important message, but what implications does it have for those taking antibiotics for long-term condition management?

It’s difficult to get reliable statistics on what proportion of antibiotic prescriptions are for chronic conditions.  NHS data doesn’t usually include any indication of why a drug is prescribed, and clinicians use many of the same medicines in different clinical contexts.

It’s safe to say that the majority of antibiotics are prescribed for short-term, acute problems like bronchitis, tonsillitis, sinusitis, or urinary tract infections. And when we talk about over-prescribing, it’s usually with respect to acute conditions.

However, antibiotics are also used to treat common long-term conditions such as acne. There are also hundreds of thousands of people who regularly use antibiotics to prevent infection, such as those with cystic fibrosis, rheumatic fever, undergoing chemo and with conditions that impact their immune systems.

So how do we control the spread of antibiotic resistance amongst this patient group? 

Improved adherence.

Taking the correct antibiotic at the right time, without missing a dose, ensures an effective and steady level of the medication in the blood that can fight infection or prevent opportunistic infections from becoming established in the body.

Missing doses or taking them at the wrong time means that the antibiotic blood levels can fall below the level required for them to be effective. This allows bacteria that are less sensitive to the specific antibiotic to grow in number and we now know that there are many ways that the resistance can be read between bacteria which amplifies the problem.

Between a third and half of all medication isn't taken as directed, and this applies to antibiotics as much as anything else. Long-term antibiotic prescribing isn’t going to go away, that’s why it's critical we address adherence. 

Further reading

Dr Diane Ashiru-Oredope is the Pharmacist Lead for Antimicrobial Resistance and Stewardship at Public Health England. She wrote this very informative blog post on why antimicrobial resistance is such a major issue and it’s well worth a read.

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