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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: URTI
57 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 16L..00 | Read | Influenza-like symptoms | diagnostic | res20: URTI | |||
| 1J72.00 | Read | Suspected swine influenza | diagnostic | res20: URTI | |||
| H0...00 | Read | Acute respiratory infections | diagnostic | res20: URTI | |||
| H00..00 | Read | Acute nasopharyngitis | diagnostic | res20: URTI | |||
| H00..11 | Read | Common cold | diagnostic | res20: URTI | |||
| H00..12 | Read | Coryza - acute | diagnostic | res20: URTI | |||
| H00..13 | Read | Febrile cold | diagnostic | res20: URTI | |||
| H00..14 | Read | Nasal catarrh - acute | diagnostic | res20: URTI | |||
| H00..15 | Read | Pyrexial cold | diagnostic | res20: URTI | |||
| H00..16 | Read | Rhinitis - acute | diagnostic | res20: URTI | |||
| H023z00 | Read | Acute bacterial pharyngitis NOS | diagnostic | res20: URTI | |||
| H024.00 | Read | Acute viral pharyngitis | diagnostic | res20: URTI | |||
| H02z.00 | Read | Acute pharyngitis NOS | diagnostic | res20: URTI | |||
| H03..00 | Read | Acute tonsillitis | diagnostic | res20: URTI | |||
| H03..11 | Read | Throat infection - tonsillitis | diagnostic | res20: URTI | |||
| H036.00 | Read | Acute viral tonsillitis | diagnostic | res20: URTI | |||
| H03z.00 | Read | Acute tonsillitis NOS | diagnostic | res20: URTI | |||
| H04..00 | Read | Acute laryngitis and tracheitis | diagnostic | res20: URTI | |||
| H040.00 | Read | Acute laryngitis | diagnostic | res20: URTI | |||
| H040w00 | Read | Acute viral laryngitis unspecified | diagnostic | res20: URTI | |||
| H040z00 | Read | Acute laryngitis NOS | diagnostic | res20: URTI | |||
| H041.00 | Read | Acute tracheitis | diagnostic | res20: URTI | |||
| H041000 | Read | Acute tracheitis without obstruction | diagnostic | res20: URTI | |||
| H041100 | Read | Acute tracheitis with obstruction | diagnostic | res20: URTI | |||
| H041z00 | Read | Acute tracheitis NOS | diagnostic | res20: URTI | |||
| H042.00 | Read | Acute laryngotracheitis | diagnostic | res20: URTI | |||
| H042000 | Read | Acute laryngotracheitis without obstruction | diagnostic | res20: URTI | |||
| H042100 | Read | Acute laryngotracheitis with obstruction | diagnostic | res20: URTI | |||
| H042.11 | Read | Laryngotracheitis | diagnostic | res20: URTI | |||
| H042z00 | Read | Acute laryngotracheitis NOS | diagnostic | res20: URTI | |||
| H04z.00 | Read | Acute laryngitis and tracheitis NOS | diagnostic | res20: URTI | |||
| H05..00 | Read | Other acute upper respiratory infections | diagnostic | res20: URTI | |||
| H050.00 | Read | Acute laryngopharyngitis | diagnostic | res20: URTI | |||
| H051.00 | Read | Acute upper respiratory tract infection | diagnostic | res20: URTI | |||
| H052.00 | Read | Pharyngotracheitis | diagnostic | res20: URTI | |||
| H054.00 | Read | Recurrent upper respiratory tract infection | diagnostic | res20: URTI | |||
| H055.00 | Read | Pharyngolaryngitis | diagnostic | res20: URTI | |||
| H05y.00 | Read | Other upper respiratory infections of multiple sites | diagnostic | res20: URTI | |||
| H05z.00 | Read | Upper respiratory infection NOS | diagnostic | res20: URTI | |||
| H05z.11 | Read | Upper respiratory tract infection NOS | diagnostic | res20: URTI | |||
| H05z.12 | Read | Viral upper respiratory tract infection NOS | diagnostic | res20: URTI | |||
| H06z111 | Read | Respiratory tract infection | diagnostic | res20: URTI | |||
| H0z..00 | Read | Acute respiratory infection NOS | diagnostic | res20: URTI | |||
| H27..00 | Read | Influenza | diagnostic | res20: URTI | |||
| H271.00 | Read | Influenza with other respiratory manifestation | diagnostic | res20: URTI | |||
| H271000 | Read | Influenza with laryngitis | diagnostic | res20: URTI | |||
| H271100 | Read | Influenza with pharyngitis | diagnostic | res20: URTI | |||
| H271z00 | Read | Influenza with respiratory manifestations NOS | diagnostic | res20: URTI | |||
| H27yz00 | Read | Influenza with other manifestations NOS | diagnostic | res20: URTI | |||
| H27z.00 | Read | Influenza NOS | diagnostic | res20: URTI | |||
| H27z.11 | Read | Flu like illness | diagnostic | res20: URTI | |||
| H27z.12 | Read | Influenza like illness | diagnostic | res20: URTI | |||
| H29..00 | Read | Avian influenza | diagnostic | res20: URTI | |||
| H2A.. | Read | Influenza A (H1N1) swine flu | diagnostic | res20: URTI | |||
| H5yy.11 | Read | Respiratory infection NOS | diagnostic | res20: URTI | |||
| Hyu0.00 | Read | [X]Acute upper respiratory infections | diagnostic | res20: URTI | |||
| Hyu0300 | Read | [X]Other acute upper respiratory infections/multiple sites | diagnostic | res20: URTI |
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