“There is always a flipside….”

It is fascinating to compare differences in antibiotic prescribing practices between New Zealand and the UK.

In the UK, due to high MRSA and C. difficile rates there has been a national drive to reduce/eradicate routine prescribing of cephalosporins and beta-lactam/beta lactamase inhibitor combinations. This (along with increased infection control measures) has had dramatic effects on MRSA and C. difficile rates. When I left for New Zealand in 2006, MRSA rates in the UK were up at 35% of all Staph aureus isolates. Now on my return it is down closer to 10%, much the same as in New Zealand.

However there are potential downsides to such a change. As a consequence there is much more prescribing of gentamicin for Gram negative cover. It is generally given to more patients and in longer duration. This potentially increases the risk of both ototoxicity and nephrotoxity. There is also increased prescribing of vancomycin and possibly as a consequence, Vancomycin Resistant Enterococci are more of an issue in the UK than in NZ, where they are very rare.

In terms of efficacy, beta-lactams are often thought of as the most efficacious antibiotics, so there is also a potential concern that avoidance of these antibiotics (with the exception of amoxycillin) may lead to increased numbers of clinical failures. To prove this objectively however would be incredibly difficult, if not impossible.

It is interesting that some of my antibiotic recommendations/advice given in New Zealand would be seen as ridiculous here in the UK, and vice versa…. Not wishing to look like the fool that I am,  I have learnt to adapt very quickly to the prescribing culture here!

Nevertheless it is difficult to argue with the very impressive reductions in MRSA and C.diff rates here in the UK . However there is always a flipside….



5 thoughts on ““There is always a flipside….”

  1. Thanks Michael for a very interesting post.

    Where would be a good place to find out about UK prescribing guidelines/rates so I can flesh out the sort of issues you are highlighting here?



    1. I think each guideline is trust specific as opposed to there being a national guideline. If you google first line empirical antibiotic therapy for adult patients uk, then you will get a selection to have a look at.

    1. Hi Massimo, I think there is still quite a bit of use of Hartford nomograms or similar in the UK. It is fascinating to observe the different prescribing cultures, almost analogous to speaking a different language.
      Hope all is going well for you in your new job.

      1. Hi Michael
        Oh why I am not surprised about the Hartford nomogram? LOL
        Yes all good here, winter has been very mild (and it’s almost finished!). The new job is lots of fun, among other things I can do my own Grams and look at the slides myself.

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