The 2005 Garrod Lecture: the changing access of patients to antibiotics--for better or worse?

Expanding the range of health professionals who can supply prescription medicines has been a policy of the UK National Health Service (NHS) since 2000, the most recent change being the establishment of nurse and pharmacist independent prescribers. In addition, patients now have a wider choice of how they access treatment for infections, particularly through the availability of antibiotics through community pharmacists under Patient Group Directions and Supplementary Prescribing. There is also a drive to reclassify medicines where possible from Prescription Only to Pharmacy Medicines. Patients can easily obtain antibiotics via the Internet, now available in more than half of UK households, and from their own and others' leftovers of prescribed courses. The first of these has considerable hazards for individual patients. The benefits to patients of the regulatory changes are largely ease of access to treatment for relatively minor illnesses, and their increased awareness and self-reliance that comes from this. More informed self-care should encourage the better use of healthcare resources. There could also be financial savings for the NHS if more patients purchased their medicines. Information on whether the changes in access have led to increased usage is scanty, since information on some of the supply is not collected. No doubt some of the usage from non-medical sources will be substitution, although there may well be an increase overall. It is possible that supply by non-medical professionals could lead to a closer adherence to protocols for the use of antibiotics. Whether the changes in access will have an impact on the prevalence of antimicrobial resistance is even harder to determine, especially as there is still much uncertainty about which parameters of antibiotic consumption encourage resistance. Within the context of the widespread use of antibiotics from extra-regulatory sources, it is hard to see how a modest increase in usage resulting from the changes in the regulations would have a significant impact on resistance. One issue to emerge from these changes is the mixed message given by official sources on antibiotic usage, with on the one hand placing an emphasis on containing resistance (and hence restricting antibiotic use) and on the other widening access and encouraging the reclassification of antimicrobials.