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Research article:
Trends in antibiotic prescribing in primary care for clinical syndromes subject to national recommendations to reduce antibiotic resistance, UK 1995-2011: analysis of a large database of primary care consultations
Reference:
Jeremy I. Hawker; Sue Smith; Gillian E. Smith; Roger Morbey; Alan P. Johnson; Douglas M. Fleming; Laura Shallcross; Andrew C. Hayward(2014) Trends in antibiotic prescribing in primary care for clinical syndromes subject to national recommendations to reduce antibiotic resistance, UK 1995-2011: analysis of a large database of primary care consultations. Journal of Antimicrobial Chemotherapy, doi: 10.1093/jac/dku291
- Link to fulltext article
- Abstract
- Objectives To measure trends in antibiotic prescribing in UK primary care in relation to nationally recommended best practice. Patients and methods A descriptive study linking individual patient data on diagnosis and prescription in a large primary care database, covering 537 UK general practices during 1995–2011. Results The proportion of cough/cold episodes for which antibiotics were prescribed decreased from 47% in 1995 to 36% in 1999, before increasing to 51% in 2011. There was marked variation by primary care practice in 2011 [10th–90th percentile range (TNPR) 32%–65%]. Antibiotic prescribing for sore throats fell from 77% in 1995 to 62% in 1999 and then stayed broadly stable (TNPR 45%–78%). Where antibiotics were prescribed for sore throat, recommended antibiotics were used in 69% of cases in 2011 (64% in 1995). The use of recommended short-course trimethoprim for urinary tract infection (UTI) in women aged 16–74 years increased from 8% in 1995 to 50% in 2011; however, a quarter of practices prescribed short courses in ≤16% of episodes in 2011. For otitis media, 85% of prescriptions were for recommended antibiotics in 2011, increasing from 77% in 1995. All these changes in annual prescribing were highly statistically significant (P < 0.001). Conclusions The implementation of national guidelines in UK primary care has had mixed success, with prescribing for coughs/colds, both in total and as a proportion of consultations, now being greater than before recommendations were made to reduce it. Extensive variation by practice suggests that there is significant scope to improve prescribing, particularly for coughs/colds and for UTIs.
- Author for correspondence
- Jeremy I. Hawker
- Email for correspondence
- jeremy.hawker@phe.gov.uk
Code list: res20: cough/cold
13 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 1656.00 | Read | Feverish cold | diagnostic | res20: cough/cold | |||
| 171..00 | Read | Cough | diagnostic | res20: cough/cold | |||
| 171..11 | Read | C/O - cough | diagnostic | res20: cough/cold | |||
| 1712.00 | Read | Dry cough | diagnostic | res20: cough/cold | |||
| 1713.00 | Read | Productive cough -clear sputum | diagnostic | res20: cough/cold | |||
| 171F.00 | Read | Cough with fever | diagnostic | res20: cough/cold | |||
| 171Z.00 | Read | Cough symptom NOS | diagnostic | res20: cough/cold | |||
| H00..00 | Read | Acute nasopharyngitis | diagnostic | res20: cough/cold | |||
| H00..11 | Read | Common cold | diagnostic | res20: cough/cold | |||
| H00..12 | Read | Coryza - acute | diagnostic | res20: cough/cold | |||
| H00..13 | Read | Febrile cold | diagnostic | res20: cough/cold | |||
| H00..15 | Read | Pyrexial cold | diagnostic | res20: cough/cold | |||
| R062.00 | Read | [D]Cough | diagnostic | res20: cough/cold |
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