Trends in antibiotic prescribing in primary care for clinical syndromes subject to national recommendations to reduce antibiotic resistance, UK 1995-2011: analysis of a large database of primary care consultations.

Abstract

OBJECTIVES:

To measure trends in antibiotic prescribing in UK primary care in relation to nationally recommended best practice.

PATIENTS AND METHODS:

A descriptive study linking individual patient data on diagnosis and prescription in a large primary care database, covering 537 UK general practices during 1995-2011.

RESULTS:

The proportion of cough/cold episodes for which antibiotics were prescribed decreased from 47% in 1995 to 36% in 1999, before increasing to 51% in 2011. There was marked variation by primary care practice in 2011 [10th-90th percentile range (TNPR) 32%-65%]. Antibiotic prescribing for sore throats fell from 77% in 1995 to 62% in 1999 and then stayed broadly stable (TNPR 45%-78%). Where antibiotics were prescribed for sore throat, recommended antibiotics were used in 69% of cases in 2011 (64% in 1995). The use of recommended short-course trimethoprim for urinary tract infection (UTI) in women aged 16-74 years increased from 8% in 1995 to 50% in 2011; however, a quarter of practices prescribed short courses in ≤16% of episodes in 2011. For otitis media, 85% of prescriptions were for recommended antibiotics in 2011, increasing from 77% in 1995. All these changes in annual prescribing were highly statistically significant (P < 0.001).

CONCLUSIONS:

The implementation of national guidelines in UK primary care has had mixed success, with prescribing for coughs/colds, both in total and as a proportion of consultations, now being greater than before recommendations were made to reduce it. Extensive variation by practice suggests that there is significant scope to improve prescribing, particularly for coughs/colds and for UTIs.

• Authors: Jeremy I Hawker, Sue Smith, Gillian E Smith, Roger Morbey, Alan P Johnson, Douglas M Fleming, Laura Shallcross, Andrew C Hayward
• Journal: The Journal of antimicrobial chemotherapy (J Antimicrob Chemother) Vol. 69 Issue 12 Pg. 3423-30 (Dec 2014) ISSN: 1460-2091 [Electronic] England
• PMID: 25091508 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © Crown copyright 2014.

Chemical References

• Anti-Bacterial Agents

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (therapeutic use)
• Child
• Child, Preschool
• Cross-Sectional Studies
• Drug Prescriptions (standards)
• Drug Therapy (standards)
• Drug Utilization (standards)
• Female
• Guideline Adherence
• Health Policy
• Humans
• Infant
• Infant, Newborn
• Male
• Middle Aged
• Primary Health Care (methods)
• United Kingdom
• Young Adult