The numbers of patients prescribed antibiotics for winter ailments continues to rise, despite awareness campaigns. Pharmacy teams can help to spread the word this winter

We risk being ‘cast back into the dark ages of medicine’ unless we take more action to tackle the growing threat of antibiotic resistance, warned Prime Minister David Cameron in July. A review panel has been set up to examine the key issues, including the over-use of antibiotics worldwide. It’s estimated that drug-resistant strains of bacteria are responsible for 5,000 deaths in the UK and 25,000 in Europe each year.

Despite awareness-raising campaigns and government initiatives to reduce antibiotic prescribing for minor ailments, the number of patients prescribed antibiotics for colds and coughs has risen 40 per cent between 1999 and 2011, according to a new study by UCL and Public Health England. It also found there are big variations between GP practices and that 30 per cent of patients received a drug not recommended in national guidance.

Joint guidance from the RPS, RCGP, RCN and RCP in July stated that frontline health workers must fight pressure to give out unnecessary antibiotic prescriptions and tell patients about alternatives.

‘The message needs to be carefully thought out, as we do not want to frighten the public about not taking antibiotics when they are needed. But the public needs to be aware that the more antibiotics you have, the greater the chance of resistance. Good health promotion is key,’ says Dr Philip Howard, antimicrobial pharmacist and consultant pharmacist for the RPS.

Key messages

Pharmacists can play an important role by educating customers on correct use of antibiotics and how to treat the symptoms of colds and flu without the need for antibiotics. ‘Community pharmacists are the most accessible healthcare professionals, so have the opportunity to help the public understand how they can treat minor ailments themselves, using OTC medicines to manage the symptoms of their ailments. Around 45 per cent of people wrongly think antibiotics can treat winter ailments such as cold and flu; pharmacists are in the front line to change this false perception, and also help people better understand how long a common winter condition can last. There is some evidence that people who appropriately self care to start with, still end up with a GP appointment, and may be expecting antibiotics, because they assume the worst way too early,’ says Rob Darracott, chief executive of Pharmacy Voice.

Public perception of global antibiotic resistance is something that needs to be tackled at a national level

Mimi Lau, agrees: ‘Pharmacy staff can reinforce the national message locally by informing patients to come to them as their first port of call. Pharmacy staff are accessible, have time to advise and stock an armoury of OTC products to manage symptoms.’ She adds: ‘The most important advice to pass on during this season is how best to manage their symptoms using OTC remedies. They should advise plenty of rest and fluids and explain that it is a time-limited condition, so there’s no need for antibiotics.’

Terry Reid, owner of Reid’s pharmacy in Edmonton, London, and Alphega member, says: ‘When presented with a cold or flu case, we ask for a full description of symptoms so we can confirm the condition. We let the patient know what to expect and explain that it is a self-limiting condition and there is no need to visit their GP.’

Dr Howard believes a nationwide roll-out of the minor ailments scheme used in Scotland would make a big difference. ‘These have been shown to reduce consultation rates to GPs by around 50 per cent.’ He also believes pharmacists could expand on their role as public health educators. ‘Encourage better hygiene with regular hand washing, especially before eating; not sneezing over people or onto your hands then touching things. Also ensure better flu vaccine take-up.’

If antibiotics are prescribed...

When patients do receive antibiotics, they need to be encouraged to complete the course. ‘It’s easy to assume that patients will follow the advice of pharmacists and doctors, but we know it’s more complicated than that. In most localities, pharmacists are accessible seven days a week to answer any questions patients have about their medication, and a great deal of support material – including the recently launched suite of materials under the banner ‘consultation skills for pharmacy practice’ – is available to help. Pharmacists must use the information and resources available and encourage all staff to engage with the public.

‘Public perception of global antibiotic resistance is something that needs to be tackled at a national level, and is something we’re working on via our ‘Staying the course’ campaign. However, ensuring patients take their medication correctly is something that can be tackled by all pharmacists and their teams,’ says Mr Darracott. Key points to emphasise to customers are:

  • Finish the course
  • Take at the prescribed intervals
  • Check whether to take before, with or after food
  • Check for any drug interactions
  • Monitor side effects.

Flu vaccine update

Public Health England wants to increase flu vaccine uptake to a minimum of 75 per cent for those aged 65 plus and health and social care workers this season. Uptake of the vaccine in 2013/14 for patients aged six months to 65 in at-risk groups was only 52.3 per cent; for pregnant women it was 39.8 per cent; for health care workers 54.8 per cent; for carers 44.8 per cent; for children aged two 46.3 per cent and for children aged three; 39.6 per cent. Who is eligible?

  • Those aged 65+
  • Aged six months to 65 in clinical risk groups
  • Pregnant women
  • Two, three and four year olds
  • School-aged children in pilot areas
  • Those in long-stay care homes
  • Carers.

Pharmacists can alert patients in at-risk groups of the importance of being vaccinated when they come in to collect their medication. This year, the DH is asking providers to prioritise the improvement of vaccine uptake in those with chronic liver disease and neurological disease, including those with learning disabilities, who are at highest risk of mortality and lowest rate of uptake. Pharmacists should also remind carers that they are eligible for the vaccine.

Market activity

Mintel predicts growth of 13 per cent to £711 million by 2018 in the cold/flu/decongestant market. Oral OTC remedies are the most popular treatments for cold/flu and those who’ve suffered cough/sore throat are most likely to have used an OTC remedy (73 per cent). Usage of OTC remedies is higher among those with heavier work schedules, says Mintel, while 16- to 34- year-olds were the most likely to see their GP for a minor winter ailment.

‘The emphasis of preventative behaviours, such as avoiding people who are sick, having the flu jab and taking vitamins to build immunity, indicates there is an opportunity for cold/flu remedy brands to create more products with preventive actions,’ says Mintel.

At Covonia UK, marketing manager Ed Round says pharmacists need to be aware of the growing market for sugar-free and alcohol-free remedies. ‘There is a strong demand for cough remedies suitable for niche audiences and those on restrictive diets. The UK Muslim population is forecast to reach 8.2 per cent of the UK by 2030, so it’s important for pharmacists to stock sugarfree and alcohol-free remedies.’

Covonia is launching Covonia Chesty Cough Sugar Free syrup, both sugar and alcohol-free, this season. To support the launch, Covonia is investing in its largest ever TV, press, PR and social media campaign this season.

The Lemsip brand has two additions this season. Lemsip Mucus Cough sugar and colourfree, a cough liquid free from sugar and colourants. Lemsip Cough Max for Chesty Cough & Cold powder for oral solution is a hot drink remedy with paracetamol, phenylephrine hydrochloride and guaifenesin.

Olbas has a range of products to treat the whole family, including Olbas for Children, which is suitable from three months. ‘Being familiar with the Olbas range and the products suited to different ages will ensure pharmacists have the knowledge available to advise families when it comes to self-caring and the most suitable winter remedy,’ says brand manager Nikki Kerrigan.

Nasalguard Cold & Flu Block is now available for independents to stock. The drug-free gel is clinically proven to help prevent the likelihood of colds and flu by blocking airborne viruses from entering the nose. It creates an invisible barrier to capture and block airborne pathogens. It’s suitable for pregnant women and children.

Strepsils are being supported this season with a new campaign that launches in October, with a focus on treating sore throat symptoms early. It will educate consumers on the benefits of Strepsils over non-medicated sweets for effective relief and will focus on Strepsils Extra Strength.

New to the Jakemans range of menthol confectionary this winter is Peppermint flavour.

Comment

Bina Patel, Kalsons Chemists, Essex ‘I was listening to the weather forecast and I have a feeling that we might see quite a lot of colds if the weather is mild. But we don’t stock up too much for the cold and flu season, unless its a particularly fast-selling line, because we don’t have the space to store it. I tell patients with colds to have plenty of fluids and to get natural supplements by eating lots of fresh fruit and vegetables. It’s important that we don’t direct patients to the GP for antibiotics or build up the anticipation that an antibiotic is required. We need to encourage them to treat themselves better instead. I have worked as an antibiotic pharmacist in a hospital, so I tell patients to ask me if they need to go to the doctor for antibiotics or not.’

Pallavi Dawda, Masons Chemists, Coalville ‘This is our second biggest medicine category after Analgesics and very important to us and our customers, especially at this time of year. Matching the right product to the customer’s needs is key for cold and flu and this may mean suggesting a combination product or separate products for specific issues. Much of the key advice is around general health measures and, for high risk groups, making sure they are receiving their annual flu vaccination. We have been doing flu vaccines privately for a couple of years and have seen great growth. Linking products is key for cold and flu and simple add-on sales, such as tissues and inhalants, can offer customers more comfort when they are feeling rotten.’

Alan Bradley, Cornwell’s Chemist, Newcastle-under-Lyme ‘The cold and flu category is one of the biggest selling points for pharmacy and there are so many products available that there is always something suitable for a customer, regardless of what medication they are taking. If a customer comes in with cold and flu symptoms we would generally recommend a menthol-based product to improve their breathing. We always advise them to use products that won’t interact with any other medication. One of our favourites, due to its extensive use and the fact it doesn’t interact with any other medicine, is Lemsip Max, which can be swallowed whole or dissolved if a patient has a sore throat. Another favourite is the Lemsip Cough Mixture for Mucus Coughs.’

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