Patient packs and the prescribing of antimicrobial agents

Unlike most other pharmaceutical products, antibiotics are usually prescribed for a denned period. This varies from a few days in the case of treatment of an acute bacterial infection, to several months for tuberculosis. There is considerable variation in the duration of treatment of common infections largely because the optimal course is not known. This is reflected in the section of The British National Formulary dealing with anti-infectives; for most conditions specific agents and dosages are recommended but advice as to duration is given for only a minority and, where it is provided, is often imprecise, e.g. 10-21 days for syphilis (British Medical Association & Royal Pharmaceutical Society of Great Britain, 1995). New developments in the dispensing of drugs, arising from legislation enacted by the European Community, are likely to challenge this vagueness of much antibiotic prescribing. Throughout most of Europe prescribed medicines are dispensed with patient information leaflets provided by the manufacturer. In the UK, Ireland and the Netherlands, however, many medicines are bought in bulk by pharmacists and then dispensed in individually labelled bottles with little or no information provided for the patient. A new European Community directive, which came into force in early 1994 and which is geared towards a high degree of consumer protection, requires all member states to move to dispensing drugs in a patient pack of approved size with improved labelling and an approved patient information leaflet (Council Directive 92/27 EEC, 1992). In the UK, the move towards patient pack dispensing will take place in 12 phases, starting from December 1995 but the majority of antimicrobial agents will not be affected until Phase 10, due in March 1998. Patient pack dispensing will have its greatest effect outside hospitals where 90% of all drugs are dispensed and should ensure that patients are better informed about the medicines they take. For many drugs used chronically, this initiative will result in little change; the pack size will be for 28 days' treatment and doctors will prescribe a pack rather than specify the number of days of treatment. In the UK, antibiotic packs are likely to be for 5 to 7 days but these may vary elsewhere in Europe according to local practice. There are four main arguments in favour of patient pack prescribing: improved compliance , patient and medical assurance, enhanced drug safety and more effective use (Association of the British Pharmaceutical Industry, 1995). Improved compliance should …