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. 2022 Feb 23;77(3):799-802.
doi: 10.1093/jac/dkab443.

Respiratory antibacterial prescribing in primary care and the COVID-19 pandemic in England, winter season 2020-21

Amelia Andrews  1   2   3 , Sabine Bou-Antoun  1   4 , Rebecca Guy  1 , Colin S Brown  1   4 , Susan Hopkins  1   2   4 , Sarah Gerver  1   2   4
Affiliations

Respiratory antibacterial prescribing in primary care and the COVID-19 pandemic in England, winter season 2020-21

Amelia Andrews et al. J Antimicrob Chemother. .

Abstract

Background: Antibacterial prescribing for respiratory tract infections (RTIs) accounts for almost half of all prescribing in primary care. Nearly a quarter of antibacterial prescribing in primary care is estimated to be inappropriate, the greatest being for RTIs. The COVID-19 pandemic has changed the provision of healthcare services and impacted the levels of antibacterials prescribed.

Objectives: To describe the changes in community antibacterial prescribing for RTIs in winter 2020-21 in England.

Methods: RTI antibacterial prescribing was measured in prescription items/1000 population for primary care from January 2014 and in DDDs/1000 population/day for the totality of RTI prescribing [combined with Accident & Emergency (A&E) in secondary care], from January 2016 to February 2021. Trends were assessed using negative binomial regression and seasonally adjusted interrupted time-series analysis.

Results: Antibacterials prescribed for RTIs reduced by a further 12.4% per season compared with pre-COVID (P < 0.001). In winter 2020-21, RTI prescriptions almost halved compared with the previous winter in 2019-20 (P < 0.001). The trend observed for total RTI prescribing (primary care with A&E) was similar to that observed in the community alone.

Conclusions: During COVID-19, RTI prescribing reduced in the community and the expected rise in winter was not seen in 2020-21. We found no evidence that RTI prescribing shifted from primary care to A&E in secondary care. The most likely explanation is a decrease in RTIs and presentations to primary care associated with national prevention measures for COVID-19.

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Figures

Figure 1.
Figure 1.
Interrupted time-series for all RTI antibacterial prescription items prescribed/1000 population in primary care by season, showing the counterfactual scenario (in black dots), England, 2014–15 to 2020–21.
Figure 2.
Figure 2.
All RTI antibacterials prescribed in primary care (prescription items/1000 population) and primary care with A&E (DDDs/1000 population/day), England, January 2016 to February 2021.
See this image and copyright information in PMC

References

    1. English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) Report 2019-2020. https://assets.publishing.service.gov.uk/government/uploads/system/uploa....
    1. Dolk FCK, Pouwels KB, Smith DRM. et al. Antibiotics in primary care in England: which antibiotics are prescribed and for which conditions? J Antimicrob Chemother 2018; 73: ii2–10. - PMC - PubMed
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    1. Bou-Antoun S, Costelloe C, Honeyford K. et al. Age-related decline in antibiotic prescribing for uncomplicated respiratory tract infections in primary care in England following the introduction of a national financial incentive (the Quality Premium) for health commissioners to reduce use of antibiotics in the community: an interrupted time series analysis. J Antimicrob Chemother 2018; 73: 2883–92. - PubMed
    1. Smieszek T, Pouwels KB, Dolk FCK. et al. Potential for reducing inappropriate antibiotic prescribing in English primary care. J Antimicrob Chemother 2018; 73: ii36–43. - PMC - PubMed

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