GPs more cautious when prescribing antibiotics

Introduction: New reimbursement rules make GPs more cautious when prescribing antibiotics. UAntwerp’s iCAREdata project shows immediate impact of stricter conditions.

Stricter conditions for the reimbursement of certain antibiotics have been in force since 1 May 2018. The measure is intended to counter the overconsumption of antibiotics and reduce the development of resistance. According to data from the GP practices participating in the iCAREdata project ( https://icare.uantwerpen.be ), GPs have since become more cautious about prescribing antibiotics.

Belgium needs to do better when it comes to using antibiotics. Much better. The total amount of antibiotics we use remains far too high and doctors still prescribe antibiotics too often when they are not needed for treatment. They also prescribe too many newer, more expensive broad-spectrum antibiotics, especially those in the quinolone and fluoroquinolone categories.

“Both of these issues are detrimental to public health”, says Prof. Samuel Coenen (UAntwerp). “Unnecessary use of the wrong antibiotics not only leads to undesirable side effects, but also makes bacteria insensitive (resistant) to the antibiotics that we do have. If we continue like this, we will eventually run out of effective antibiotics for patients who really need them, to treat pneumonia, for example, or to enable us to operate safely.”

The prescription of antibiotics, and the choice of the right products, is the responsibility of physicians, not patients. Despite the fact that guidelines exist for doctors on the proper use of antibiotics, as well as individual feedback on doctors’ antibiotic-prescribing behaviour, 10% of the antibiotics reimbursed in Belgium are quinolones and fluoroquinolones.

No longer prescribed for respiratory infections

Coenen explains: “That figure is unacceptable for public health. The Belgian Antibiotic Policy Coordination Committee (BAPCOC) therefore wants to halve the proportion of quinolones and fluoroquinolones to below 5%. In order to limit the irresponsible use of these antibiotics, while also ensuring they can still be used if really necessary, the conditions for the reimbursement of quinolones and fluoroquinolones were changed on 1 May 2018. Now, these antibiotics will no longer be reimbursed for the treatment of respiratory tract infections or uncomplicated urinary tract infections.”

The new measure was introduced with little fanfare and no information campaign. But have the stricter rules done anything to reduce the irresponsible use of quinolones in our country? The answer is provided by the iCAREdata project (Improving Care And Research Electronic Data Trust Antwerpen, www.icaredata.eu ). iCAREdata collects information from seven out-of-hours GP practices in Flanders which provide evening and weekend services to 1 127 153 patients, and operates in accordance with the General Data Protection Regulation (GDPR).

Objective achieved immediately

“We calculated the proportion of quinolones and fluoroquinolones in the total amount of antibiotics prescribed by the participating GP practices before and after 1 May 2018,” says data manager Dr Stefaan Bartholomeeusen. “Our data shows that the share of these particular antibiotics has declined since the introduction of the measure on 1 May 2018. What’s more, the BAPCOC target was achieved for the first time last weekend: less than 5% of the antibiotics prescribed were quinolones and fluoroquinolones (4.2%).”

Data on weekend GP services collected until 8 o'clock on a given Monday morning is available in the iCAREdata database by that same afternoon. Bartholomeeusen: “This shows that iCAREdata is an incredibly useful research tool for assessing the effect of interventions in prescribing behaviour extremely quickly. The change in reimbursement conditions for quinolones and fluoroquinolones appears to have had an effect almost immediately. Whether or not the share of these antibiotics remains below 5% is something we can continue to monitor using iCAREdata.”