Despite the threat to global health posed by antibiotic resistance, various attempts to reduce over-prescribing of these drugs have not worked that well so far. And while the rates of antibiotic prescribing in UK general practice have fallen in recent years, they still remain high, say the researchers.
To find out if there might be any link between antibiotic and general prescribing levels in primary care, the researchers analysed NHS digital practice prescribing data (NHS-DPPD) for 2014–15 for 6517 general practices in England, and data from 587 general practices in the UK Clinical Practice Research Datalink (CPRD) for a replication study.
NHS-DPPD practices prescribed an average of 576.1 antibiotics per 1000 patients a year (329.9 at the 5th percentile and 808.7 at the 95th percentile).
The prescribing of antibiotics and other medicines was strongly correlated. Practices with high levels of prescribing of other medicines (a rate of 27159.8 at the 95th percentile) prescribed 80 per cent more antibiotics than low-prescribing practices (rate of 8815.9 at the 5th percentile).
After taking account of potentially influential factors, NHS-DPPD practices with high-prescribing rates for other medicines still gave out 60 per cent more antibiotic prescriptions than low-prescribing practices (corresponding to higher prescribing of 276.3 antibiotics per 1000 patients per year).
Prescribing of non-opioid painkillers and benzodiazepines were also strong indicators of the level of antibiotic prescribing.
NHS-DPPD practices with high levels of prescribing of non-opioid painkillers gave 60 per cent more antibiotics than low-prescribing practices. Benzodiazepine prescribing was also strongly related to antibiotic prescribing with a difference of 30 per cent, after statistical adjustment, between low- and high-prescribing NHS-DPPD practices.
Similar results were found for CPRD practices.
General prescribing levels were also a much stronger driver for antibiotic prescribing than other risk factors, such as deprivation, the analysis showed.
Approaches that address overall practice prescribing (including antibiotics and other types of medicine) may be more effective than those focusing only on the prescribing of antibiotics, suggest the researchers.
New approaches to changing prescribing patterns could therefore include measures such as integrating pharmacists within practices, regular reviews of overall prescribing behaviour, and comparison with similar practices, they say.
“The propensity of GPs to prescribe medications generally is an important driver for antibiotic prescribing. Interventions that aim to optimise antibiotic prescribing will need to target general prescribing behaviours, in addition to specifically targeting antibiotics,” they conclude.
*Li Y, et al. Relationship between prescribing of antibiotics and other medicines in primary care: a cross-sectional study. British Journal of General Practice, 2018. DOI:10.3399/bjgp18X700457