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. 2019 Jul 9;9(7):e023989.
doi: 10.1136/bmjopen-2018-023989.

Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study

Xiaohui Sun  1 , Martin C Gulliford  1
Affiliations

Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study

Xiaohui Sun et al. BMJ Open. .

Abstract

Objective: To analyse individual-patient electronic health records to evaluate changes in antibiotic (AB) prescribing in England for different age groups, for male and female subjects, and by prescribing indications from 2014 to 2017.

Methods: Data were analysed for 102 general practices in England that contributed data to the UK Clinical Practice Research Datalink (CPRD) from 2014 to 2017. Prescriptions for all ABs and for broad-spectrum β-lactam ABs were evaluated. Relative rate reductions (RRR) were estimated from a random-effects Poisson model, adjusting for age, gender, and general practice.

Results: Total AB prescribing declined from 608 prescriptions per 1000 person-years in 2014 to 489 per 1000 person-years in 2017; RRR 6.9% (95% CI 6.6% to 7.1%) per year. Broad-spectrum β-lactam AB prescribing decreased from 221 per 1000 person-years in 2014 to 163 per 1000 person-years in 2017; RRR 9.3% (9.0% to 9.6%) per year. Declines in AB prescribing were similar for men and women but the rate of decline was lower over the age of 55 years than for younger patients. All AB prescribing declined by 9.8% (9.6% to 10.1%) per year for respiratory infections, 5.7% (5.2% to 6.2%) for genitourinary infections, but by 3.8% (3.1% to 4.5%) for no recorded indication. Overall, 38.8% of AB prescriptions were associated with codes that did not suggest specific clinical conditions, and 15.3% of AB prescriptions had no medical codes recorded.

Conclusion: Antibiotic prescribing has reduced and become more selective but substantial unnecessary AB use may persist. Improving the quality of diagnostic coding for AB use will help to support antimicrobial stewardship efforts.

Keywords: epidemiology; primary care; public health; respiratory infections.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Proportion of patients prescribed antibiotics (ABs) in one year by age-group and calendar year.
Figure 2
Figure 2
Forest plot showing annual relative reduction (95% CI) in antibiotic (AB) prescribing for all ABs and broad-spectrum β-lactam ABs between 2014 and 2017 for subgroups of age and gender and different prescribing indications. Estimates were adjusted for age, gender, and clustering by practice.
Figure 3
Figure 3
Bar chart showing changes from 2014 to 2017 in the proportion of antibiotic prescriptions for different antibiotic classes for male and female subjects. UTI, urinary tract infection.
See this image and copyright information in PMC

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