A lot has been written on antimicrobial resistance and on the ways and means to contain it. One most important link in the control or lack of control of antimicrobial resistance is the prescribing habit of doctors. The hospital setting, where doctors are working as a team, and the prescription of antimicrobial agents is more often supported by the microbiology laboratory, provides the infrastructure and chain of command needed for the implementation and evaluation of containment programmes. How about the primary care setting?

In the present issue of The Hong Kong Practitioner, there are three articles on the use of antibiotics in the primary care setting and one article exploring the correlation between the clinical features of sore throat and its bacteriology. HC Chan studied antibiotic use by patients prior to a general practice consultation and antibiotic prescription by the general practitioner at the consultation. JA Dickinson and CSY Chan studied how Hong Kong primary care doctors use antibiotics for respiratory disease. K Choi reported on a sore throat study in general practice setting. CLK Lam gave a synopsis on rational prescribing for upper respiratory infection. These papers reflected the intensity among practising and academic family physicians on the need to address the problem of antimicrobial resistance, and will undoubtedly increase the awareness of readers on the subject.

The questions I often ask are: Would these and similar articles together with an occasional lecture on the subject be effective in modifying the prescribing habit of the primary care doctors, if not, what else needs to be done? Do we have the tools to evaluate the effectiveness of the measures taken?

In an attempt to answer these questions, The Hong Kong Medical Association in conjunction with The Department of Health, The Hospital Authority, The Departments of Medicine and Microbiology of Queen Mary Hospital, The Department of Family Medicine of The Chinese University of Hong Kong and esteemed doctors associations, organised a programme with the objective to develop, implement, and evaluate the effectiveness of measures for modifying the antimicrobial prescribing habit of primary care doctors.

The first phase of the programme was implemented last year. It consisted of a consensus-building forum during which the 300 participating doctors discussed the wordings and design of 3 items:-

1. A poster for public education to be put up at their clinics,

2. An information leaflet on antibiotics and the appropriate use of antibiotics to be used by doctors to educate their patients, and

3. Advice for doctors on when not to use antibiotics for respiratory infections.

The organisers did not publish these items on their own; instead they allowed the fullest possible participation of the end-users before putting them to print. The end result was a doctors' poster, a doctors' information leaflet, and advice on the use of antibiotics that has the support of a large number of doctors. The organisers attempted to modify the prescribing habit of doctors by encouraging them to claim "ownership" of the problem.

The second phase of the programme will be implemented during the second half of this year. This phase consists of a series of intensive tutorials on antibiotics for primary care doctors working at the various districts of Hong Kong. Doctors will also be encouraged to self-audit their antibiotic use, as a measure to reinforce rational prescribing habits. The tutors will themselves undergo training to make sure that their tutorials will be relevant to primary care. The tutors will go to the districts for the tutorials so as to better understand the district setting and develop better communication with the participating doctors.

The third phase would be a 3-year pilot project to monitor the utilisation trend of a number of antibiotics or groups of antibiotics. A number of antibiotics or groups of antibiotics would be chosen as markers to reflect the utilisation of antibiotics in Hong Kong, and to evaluate whether the intervention of the first two phases has been effective. A retrospective analysis on existing data on antibiotic utilisation would also be done to serve as the baseline. This pilot project might help to establish a model for routine utilisation review on antibiotics for Hong Kong. The implementation of this phase depends on the availability of funds.

One important outcome of any successful programme to contain antimicrobial resistance must be a sustainable improvement in the prescribing habit of doctors. I urge readers to contribute in every possible manner to ensure this favourable outcome for the ongoing programmes.