Actual versus 'ideal' antibiotic prescribing for common conditions in English primary care

Abstract

Objectives: Previous work based on guidelines and expert opinion identified 'ideal' prescribing proportions-the overall proportion of consultations that should result in an antibiotic prescription-for common infectious conditions. Here, actual condition-specific prescribing proportions in primary care in England were compared with ideal prescribing proportions identified by experts.

Methods: All recorded consultations for common infectious conditions (cough, bronchitis, exacerbations of asthma or chronic obstructive pulmonary disease, sore throat, rhinosinusitis, otitis media, lower respiratory tract infection, upper respiratory tract infection, influenza-like illness, urinary tract infection, impetigo, acne, gastroenteritis) for 2013-15 were extracted from The Health Improvement Network (THIN) database. The proportions of consultations resulting in an antibiotic prescription were established, concentrating on acute presentations in patients without relevant comorbidities. These actual prescribing proportions were then compared with previously established 'ideal' proportions by condition.

Results: For most conditions, substantially higher proportions of consultations resulted in an antibiotic prescription than was deemed appropriate according to expert opinion. An antibiotic was prescribed in 41% of all acute cough consultations when experts advocated 10%. For other conditions the proportions were: bronchitis (actual 82% versus ideal 13%); sore throat (actual 59% versus ideal 13%); rhinosinusitis (actual 88% versus ideal 11%); and acute otitis media in 2- to 18-year-olds (actual 92% versus ideal 17%). Substantial variation between practices was found.

Conclusions: This work has identified substantial overprescribing of antibiotics in English primary care, and highlights conditions where this is most pronounced, particularly in respiratory tract conditions.

Figure 1.

Proportion of acute cough consultations resulting in an antibiotic prescription on the same day among patients without comorbidity. Each dot represents a practice. The solid red line represents the weighted mean (41%) and the dashed red lines its 95% CI. The blue dotted/dashed line represents the ideal prescribing proportion based on the expert elicitation and the blue dotted lines its IQR.

Figure 2.

Proportion of sore throat consultations resulting in an antibiotic prescription on the same day among patients without comorbidity. Each dot represents a practice. The solid red line represents the weighted mean (59%) and the dashed red lines its 95% CI. The blue dotted/dashed line represents the ideal prescribing proportion based on the expert elicitation and the blue dotted lines its IQR.

Figure 3.

Proportion of urinary tract infection consultations resulting in an antibiotic prescription on the same day among female patients aged >14 years without comorbidity. Each dot represents a practice. The solid red line represents the weighted mean (92%) and the dashed red lines its 95% CI. The blue dotted/dashed line represents the ideal prescribing proportion based on the expert elicitation and the blue dotted lines its IQR.