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GP prescribing of antibiotics drops by 6% in three years

GP antibiotic prescribing has decreased by 6.1% in a three-year period, Public Health England has said.

A report on antibiotic prescribing and resistance, published today, said ‘general practice was the largest prescribing setting and consumption decreased from 17.3 to 16.2 [defined daily doses] per 1,000 inhabitants per day (- 6.1%) between 2012 and 2015’.

Prescribing in secondary care was ‘broadly stable’ between 2012 and 2015. There was a 7% decrease in prescribing by dentists and an 11% increase among ‘other community prescribers’ but the report said that because this group contibutes less than 4% of the total, ‘the decreases in prescribing from GP were not substantively offset’ by this.

The PHE’s audit further found that:

  • Total antibiotic consumption (measured as defined daily dose [DDD] declined significantly between 2014 and 2015 by 4.3%, from 22.9 to 21.8 DDD per 1000 inhabitants per day;
  • Antibiotic prescribing predominantly occurs in general practice (74%), followed by hospital inpatients (11%), and outpatients (7%). The remainder comprised use in dental practice (5%) and other community settings (3%);
  • Antibiotic prescriptions in primary care, measured as the number of prescriptions dispensed, adjusted for the age and sex distributions in the population has declined for the last four years and is now lower than the similar measure in 2011;
  • Broad-spectrum antibiotic use (antibiotics that are effective against a wide range of bacteria and more likely to drive antibiotic resistance than narrow-spectrum antibiotics) continues to decrease in primary care and England now uses the lowest amounts of cephalosporins and quinolones in the EU;
  • Compared with other UK health administrations, England has the lowest primary care prescribing by (items and DDDs). Scotland has the lowest use of last resort antibiotics with England the second lowest use.

On antibiotic resistance, the audit found that resistance to carbapenems, a group of ‘last resort antibiotics’, remains low in bloodstream infections in England, but there is a ;wide variation in the rates of resistance’ across England.

Further, the continued increase – of 50% over five years – in the use of ‘last resort’ antibiotic piperacillin/tazobactam, wasassociated with a significant increase in resistance of both E. coli and K. pneumoniae bloodstream infections, said PHE.

The report said ‘this highlights the importance of reducing the use of piperacillin/tazobactam, as well as carbapenems, to reduce the emergence and subsequent spread of resistance’.

But the news comes as UK governments have announced schemes to allow a wider range of professionals to prescribe antibiotics.

Pharmacists in Scotland are to start prescribing antibiotics to women with urinary tract infections in a scheme designed to free up thousands of GP appointments.

Meanwhile, patients with sore throats will be directed to pharmacists for testing and treatment, under a new scheme being rolled out across England that NHS chiefs claim will help save GP appointments and cut use of antibiotics.

Earlier this year, NHS Improvement pointed to a 7% one-year drop in GP antibiotic prescribing and Dr Maureen Baker, RCGP chair, said the ‘significant drop’ reflected the hard work GPs were doing to improve appropriate prescribing, ‘despite the pressure GPs often face from patients to prescribe antibiotics’.