Abstract
Is it possible to get antibiotic prescribing right, to balance the needs of patients and the push to reduce antibiotic prescribing? In the prevailing climate of financial austerity and plunging global financial markets, every cost and investment is being scrutinised. This doesn’t much help clinicians in primary care who need to decide whether or not to prescribe an antibiotic. Often, too, patients are adamant that an antibiotic is what they need and that it has helped them in the past.
New research finds that this imagined dilemma is playing out in reality. Ali Fahmi and colleagues accessed primary care data via the OpenSAFELY platform and found that antibiotic prescription was unrelated to risk of hospital admission. 1 The implication is that prescribers rightly seeking to limit antibiotic prescriptions must not deny antibiotics to people who are vulnerable because of age, co-morbidities, and infection severity. We might also consider people’s past medical history. The point here is that the decision to prescribe is a complex one that is beyond using a simple risk score or some technological wizardry. It is a decision that calls on clinical judgement.
This prescribing behaviour has become entrenched since the covid-19 pandemic, which also brought us deep and complex debates about diagnostic testing. Some of the key people involved with testing now reflect on the rationale and impact of those strategies. 2 The main lessons are that strategies evolved with the pandemic giving us a clear template for the next one, but the authors judge that the exact approach to testing strategy remains dependent on the nature of the next pathogen.
Whatever the scenario, the principles of compassion 3 and shared decision making remain central. 4 And, as Denis Pereira Gray describes it in the first of a short series of extracts from his book, medical practice is a craft that – given the fine judgements and flexible decision making required – takes a lifetime to learn. 5