Background: Antibiotic overuse is linked with increased risk of antimicrobial resistance. Long-term antibiotics are commonly used for treating acne and prophylaxis of urinary tract infection. Their contribution to the overall burden of antibiotic use is relatively unknown. Aim: To describe the volume of commonly prescribed long-term (>= 28 days) antibiotic prescriptions in adolescents and young adults, trends over time and comparisons with acute prescriptions. Design and Setting: Retrospective cohort study using UK electronic primary care records. Methods: Patients born between 1979 and 1996 in the Care and Health Information Analytics database were included. Our main outcome measures were antibiotic prescription rates per 1000 person years, antibiotic prescription days per person year between ages 11-21. Results: 320,722 participants received a total of 710,803 antibiotic prescriptions between the ages of 11-21 from 1998 to 2017. 191,443/710,803 (26.93%) prescriptions were for long-term antibiotics (≥28 days and ≤ 6 months in duration). Long-term antibiotics accounted for more than two-thirds (72.48%) of total antibiotic exposure (days per person year). Total long-term antibiotic prescribing peaked in 2013 at just under 6 days per person year and declined to around 4 in 2017. Conclusions: Amongst adolescents and young adults, exposure to long-term antibiotics (primarily lymecycline used for acne) was much greater than for acute antibiotics and is likely to make an important contribution to antimicrobial resistance. Urgent action is needed to reduce unnecessary exposure to long-term antibiotics in this group. Increasing the use of and adherence to effective, non-antibiotic treatments for acne is key to achieving this.
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