Antibiotics in primary care in England: which antibiotics are prescribed and for which conditions?

Abstract

Objectives: To analyse antibiotic prescribing behaviour in English primary care with particular regard to which antibiotics are prescribed and for which conditions.

Methods: Primary care data from 2013-15 recorded in The Health Improvement Network (THIN) database were analysed. Records with a prescription for systemic antibiotics were extracted and linked to co-occurring diagnostic codes, which were used to attribute prescriptions to clinical conditions. We further assessed which antibiotic classes were prescribed and which conditions resulted in the greatest share of prescribing.

Results: The prescribing rate varied considerably among participating practices, with a median of 626 prescriptions/1000 patients (IQR 543-699). In total, 69% of antibiotic prescriptions (n = 3 156 507) could be linked to a body system and/or clinical condition. Of these prescriptions, 46% were linked to conditions of the respiratory tract, including ear, nose and throat (RT/ENT); leading conditions within this group were cough symptoms (22.7%), lower respiratory tract infection (RTI) (17.9%), sore throat (16.7%) and upper RTI (14.5%). After RT/ENT infections, infections of the urogenital tract (22.7% of prescriptions linked to a condition) and skin/wounds (16.4%) accounted for the greatest share of prescribing. Penicillins accounted for 50% of all prescriptions, followed by macrolides (13%), tetracyclines (12%) and trimethoprim (11%).

Conclusions: The majority of antibiotic prescriptions in English primary care were for infections of the respiratory and urinary tracts. However, in almost one-third of all prescriptions no clinical justification was documented. Antibiotic prescribing rates varied substantially between practices, suggesting that there is potential to reduce prescribing in at least some practices.

Figure 1.

Mapping prescriptions to Read codes using a hierarchical system that mapped each Read code to (i) a body system and (ii) a condition (with varying specificity, e.g. a specific diagnosis or a general symptom). All columns add up to 100%. Percentage values with large font size assume that nitrofurantoin prescriptions without a linked Read code were used to treat UTI; values in parentheses with smaller font do not make this assumption.