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GPs’ antibiotic prescribing has fallen and become more selective

Substantial unnecessary antibiotic prescribing persists – especially for older patients and those without clear diagnosis

Louise Prime

Thursday, 11 July 2019

GPs’ antibiotic prescribing in England has both reduced and become more selective, with faster reductions for broad-spectrum β-lactam antibiotics, research* has shown – but the decline was lower for patients over age 55 years, and especially slow for antibiotic prescriptions with no coded indications. The study authors said in BMJ Open that their results emphasise the value of electronic health records in providing individual-patient data for monitoring trends in antimicrobial use and targeting future efforts at antimicrobial stewardship.

The researchers analysed individual-patient electronic health records to evaluate changes in antibiotic prescribing (all antibiotics and broad-spectrum β-lactam antibiotics) in England for different patient age groups, for male and female subjects, and by prescribing indications from 2014 to 2017. Data came from 102 general practices in England that contributed data to the UK Clinical Practice Research Datalink.


Over that period, total antibiotic prescribing fell from 608 prescriptions per 1000 person-years to 489 per 1000 person-years, a relative rate reduction (RRR) of 6.9% per year, and broad-spectrum β-lactam antibiotic prescribing fell from 221 to 163 prescriptions per 1,000 person-years, RRR 9.3% per year. Rates of decline were similar for men and women patients, but were slower for patients older than 55 years than for younger patients.

The researchers also reported that antibiotic prescribing declined by 9.8% per year for respiratory infections, and 5.7% for genitourinary infections, but only by 3.8% for no recorded indication. They added that overall, more than a third (38.8%) of antibiotic prescriptions were associated with codes that did not suggest specific clinical conditions, and 15.3% had no medical codes recorded.

They concluded: “Antibiotic prescribing has reduced and become more selective but substantial unnecessary antibiotic use may persist…

“The results emphasise the utility of electronic health records for providing individual-patient data for surveillance of trends in antimicrobial use and focusing future efforts at antimicrobial stewardship where these are most needed.”


*Sun X, Gulliford MC. Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study. BMJ Open 2019; 9: e023989. doi:10.1136/bmjopen-2018-02398

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