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J Antimicrob Chemother. 2014 Dec;69(12):3423-30. doi: 10.1093/jac/dku291. Epub 2014 Aug 4.

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.

Author information

1
Field Epidemiology Service, Public Health England, 5 St Philip's Place, Birmingham B3 2PW, UK jeremy.hawker@phe.gov.uk.
2
Real-time Syndromic Surveillance Team, Public Health England, 5 St Philip's Place, Birmingham B3 2PW, UK.
3
Department of Healthcare Associated Infection and Antimicrobial Resistance, Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
4
Royal College of General Practitioners Research and Surveillance Centre, Birmingham B17 9DB, UK.
5
Department of Infection and Population Health, University College London, London NW3 4PQ, UK.

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.

KEYWORDS:

antibiotic prescribing; otitis media; primary care; respiratory tract infections; surveillance trends; urinary tract infections

PMID:
25091508
DOI:
10.1093/jac/dku291
[Indexed for MEDLINE]

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