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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.

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Field Epidemiology Service, Public Health England, 5 St Philip's Place, Birmingham B3 2PW, UK
Real-time Syndromic Surveillance Team, Public Health England, 5 St Philip's Place, Birmingham B3 2PW, UK.
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.
Royal College of General Practitioners Research and Surveillance Centre, Birmingham B17 9DB, UK.
Department of Infection and Population Health, University College London, London NW3 4PQ, UK.



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


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.


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).


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.


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

[Indexed for MEDLINE]

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