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November 2019

Primary care cuts down on antibiotic prescribing



Primary care prescribers have reduced the number of prescriptions for antibiotics by 9%, but the number of antibiotic resistant infections are still rising, official figures show.

According to the latest UK Antimicrobial Resistance Strategy report, the number of antibiotic prescriptions dispensed in the community reduced by 16.7% (from 750 to 624 per 1,000 population per year) between 2014 and 2018.

Antibiotic consumption peaked in 2014. Between 2014 and 2018 it reduced by 9% from 20.0 to 18.2 defined daily doses per 1,000 population/day. But while reductions occurred in general and dental practice, antibiotic use increased in other settings.

Although the rate of increase has slowed compared with the previous 5 years, antibiotic use in hospitals increased by 2.8% in the last 5 years.

At the same time, the number of antibiotic resistant infections has also increased: there were an estimated 60,788 antibiotic resistant severe infections in 2018, equivalent to 165 new antibiotic resistant infections per day.

The rate of bloodstream infection (BSI) in 2018 was 145 per 100,000/population (a 22% increase from 2014). The proportion of these that were resistant to key antibiotics rose for Escherichia coli and Klebsiella pneumonia, reduced for Staphylococcus aureus and remained stable for other pathogens. Death rates were higher for antibiotic resistant compared with antibiotic susceptible BSIs.

There were 1.3 million fewer scripts for broad spectrum antibiotics from 2015 to 2019, a fall of 31% .The number of prescriptions written in primary care for trimethroprim for urinary tract infections went down by more than 40% between 2017 and 2019, while scripts for nitrofurantoin increased by 27%, with no increase in resistance was detected.

You can find out more about reducing antibiotic use with the TARGET Toolkit, developed by the RCGP to 'Keep Antibiotics Working', which is now promoted by 99% of CCGs and has more than 61,000 views per year. Visit rcgp.org.uk/targetantibiotics to view antibiotic prescribing audits and access patient information leaflets to increase patient's confident to self care and to explain why many infections, including coughs, ear infections and sore throats often get better without antibiotics, and what to do if they are offered a back-up prescription for antibiotics.

Reference

Public Health England. English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) 2018-2019. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/843129/English_Surveillance_Programme_for_Antimicrobial_Utilisation_and_Resistance_2019.pdf