Has primary care antimicrobial use really been increasing? Comparison of changes in different prescribing measures for a complete geographic population 1995–2014

Neilly, Mark; Guthrie, Bruce; Santiago, Virginia Hernandez; Vadiveloo, Thenmalar; Donnan, Peter T.; Marwick, Charis

doi:10.1093/jac/dkx220

Cited by 12 publications

(13 citation statements)

References 24 publications

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“…The trends in total antibiotic utilisation reported here are consistent with national trends based on aggregate data 2. Neilly et al 26 found that increasing prescription volumes in the period up to 2013 could be accounted for by increasing dose and duration of prescriptions but we found evidence of increased antibiotic prescribing based on numbers of prescriptions alone. Consistent with our findings, Balinskaite et al 11 reported increasing rates of infection in English primary care and hospital admissions data from 2010 to 2017.…”

Section: Discussioncontrasting

confidence: 70%

Serious bacterial infections and antibiotic prescribing in primary care: cohort study using electronic health records in the UK

et al. 2020

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ObjectiveThis study evaluated whether serious bacterial infections are more frequent at family practices with lower antibiotic prescribing rates.DesignCohort study.Setting706 UK family practices in the Clinical Practice Research Datalink from 2002 to 2017.Participants10.1 million registered patients with 69.3 million patient-years’ follow-up.ExposuresAll antibiotic prescriptions, subgroups of acute and repeat antibiotic prescriptions, and proportion of antibiotic prescriptions associated with specific-coded indications.Main outcome measuresFirst episodes of serious bacterial infections. Poisson models were fitted adjusting for age group, gender, comorbidity, deprivation, region and calendar year, with random intercepts representing family practice-specific estimates.ResultsThe age-standardised antibiotic prescribing rate per 1000 patient-years increased from 2002 (male 423; female 621) to 2012 (male 530; female 842) before declining to 2017 (male 449; female 753). The median family practice had an antibiotic prescribing rate of 648 per 1000 patient-years with 95% range for different practices of 430–1038 antibiotic prescriptions per 1000 patient-years. Specific coded indications were recorded for 58% of antibiotic prescriptions at the median family practice, the 95% range at different family practices was from 10% to 75%. There were 139 759 first episodes of serious bacterial infection. After adjusting for covariates and the proportion of coded consultations, there was no evidence that serious bacterial infections were lower at family practices with higher total antibiotic prescribing. The adjusted rate ratio for 20% higher total antibiotic prescribing was 1.03, (95% CI 1.00 to 1.06, p=0.074).ConclusionsWe did not find population-level evidence that family practices with lower total antibiotic prescribing might have more frequent occurrence of serious bacterial infections overall. Improving the recording of infection episodes has potential to inform better antimicrobial stewardship in primary care.

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Section: Discussioncontrasting

confidence: 70%

Serious bacterial infections and antibiotic prescribing in primary care: cohort study using electronic health records in the UK

et al. 2020

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“…Strong improvements have also been observed in other European countries, including the Italian Region Emilia Romagna, the Netherlands, Scotland and Sweden. In Scotland, the antibiotic prescription rate in children younger than 5 years decreased by 60% from 1,612 to 634 per 1,000 persons between 1995 and 2014 [ 14 ]. In the Netherlands, antibiotic use among 0–14 year-olds, measured as packages per population, decreased by 8–17% depending on age between 2012 and 2016.…”

Section: Discussionmentioning

confidence: 99%

“…Hence, the prescription rate is a good approximation for the rate of antibiotic treatments at population level. In addition, prescription rates are robust towards alterations of dosage per prescription over time, which may arise from changes in the prescribing practice for specific drugs or changes in the mix of antibiotics used [ 14 ]. To capture possible changes in dosage per prescription over time, mean annual DDD per prescription were estimated.…”

Section: Methodsmentioning

confidence: 99%

Marked reductions in outpatient antibiotic prescriptions for children and adolescents – a population-based study covering 83% of the paediatric population, Germany, 2010 to 2018

et al. 2020

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Background Prescribing of systemic antibiotics in general and of cephalosporins in particular in German paediatric outpatients has previously been reported to be higher than in other European countries. Aim Our objective was to assess recent trends in antibiotic prescribing in German children. Methods This study was conducted as consecutive annual cross-sectional analyses and included all children aged 0–14 years (n = 9,389,183 in 2018) covered by statutory health insurance in Germany. Annual antibiotic prescription rates from 2010 to 2018 were calculated for the age groups 0–1, 2–5, 6–9 and 10–14 years. Poisson regression was used to estimate trends of prescription rates by age group and antibiotic subgroup. Results Overall, the age-standardised antibiotic prescription rate decreased significantly by 43% from 746 prescriptions per 1,000 persons in 2010 to 428 per 1,000 in 2018 (p < 0.001). Reductions were most pronounced in the age groups 0–1 year (−50%) and 2–5 years (−44%). The age group 2–5 years exhibited the highest prescription rate with 683 per 1,000 in 2018 (0–1 year: 320/1,000; 6–9 years: 417/1,000; 10–14 years: 273/1,000). Cephalosporins (second and third generation) accounted for 32% of prescribed antibiotics. Conclusions Marked reductions in antibiotic prescribing during the last decade indicate a change towards more judicious paediatric prescribing habits. Compared with other European countries, however, prescribing of second- and third-generation cephalosporins remains high in Germany, suggesting frequent first-line use of these substances for common respiratory infections. Considerable regional variations underline the need for regionally targeted interventions.

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“…However, total antimicrobial consumption expressed in DDDs/ 1000 residents-days should be interpreted carefully as it may not accurately reflect antimicrobial use. Neilly et al found an increase in antimicrobial DDDs in contrast to a decrease in the mean number of prescriptions over the study period [54]. In addition, the DDD method inaccurately estimated days of therapy when the actual daily dose was not equal to the DDD, and this method was not recommended in situations where reduced doses were advocated e.g.…”

Section: Discussionmentioning

confidence: 99%

Interventions to Improve Antimicrobial Stewardship for Older People in Care Homes: A Systematic Review

2019

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Has primary care antimicrobial use really been increasing? Comparison of changes in different prescribing measures for a complete geographic population 1995–2014

Abstract: Rising antimicrobial volumes up to 2011 were mainly due to rising DDD per prescription. Trends in dispensed drug volumes do not readily translate into information on individual exposure, which is more relevant for adverse consequences including emergence of resistance.

Cited by 12 publications

References 24 publications

Serious bacterial infections and antibiotic prescribing in primary care: cohort study using electronic health records in the UK

Serious bacterial infections and antibiotic prescribing in primary care: cohort study using electronic health records in the UK

Marked reductions in outpatient antibiotic prescriptions for children and adolescents – a population-based study covering 83% of the paediatric population, Germany, 2010 to 2018

Interventions to Improve Antimicrobial Stewardship for Older People in Care Homes: A Systematic Review

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