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      Antibiotics in primary care in England: which antibiotics are prescribed and for which conditions?

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          Abstract

          Objectives

          To analyse antibiotic prescribing behaviour in English primary care with particular regard to which antibiotics are prescribed and for which conditions.

          Methods

          Primary care data from 2013–15 recorded in The Health Improvement Network (THIN) database were analysed. Records with a prescription for systemic antibiotics were extracted and linked to co-occurring diagnostic codes, which were used to attribute prescriptions to clinical conditions. We further assessed which antibiotic classes were prescribed and which conditions resulted in the greatest share of prescribing.

          Results

          The prescribing rate varied considerably among participating practices, with a median of 626 prescriptions/1000 patients (IQR 543–699). In total, 69% of antibiotic prescriptions ( n = 3 156 507) could be linked to a body system and/or clinical condition. Of these prescriptions, 46% were linked to conditions of the respiratory tract, including ear, nose and throat (RT/ENT); leading conditions within this group were cough symptoms (22.7%), lower respiratory tract infection (RTI) (17.9%), sore throat (16.7%) and upper RTI (14.5%). After RT/ENT infections, infections of the urogenital tract (22.7% of prescriptions linked to a condition) and skin/wounds (16.4%) accounted for the greatest share of prescribing. Penicillins accounted for 50% of all prescriptions, followed by macrolides (13%), tetracyclines (12%) and trimethoprim (11%).

          Conclusions

          The majority of antibiotic prescriptions in English primary care were for infections of the respiratory and urinary tracts. However, in almost one-third of all prescriptions no clinical justification was documented. Antibiotic prescribing rates varied substantially between practices, suggesting that there is potential to reduce prescribing in at least some practices.

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          Author and article information

          Journal
          J Antimicrob Chemother
          J. Antimicrob. Chemother
          jac
          Journal of Antimicrobial Chemotherapy
          Oxford University Press
          0305-7453
          1460-2091
          February 2018
          27 February 2018
          : 73
          : Suppl 2 , Appropriateness of antibiotic prescribing in English primary care
          : ii2-ii10
          Affiliations
          [1 ]Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
          [2 ]PharmacoTherapy, -Epidemiology & -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
          [3 ]MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, UK
          Author notes
          Corresponding author. Modelling and Economics Unit, National Infection Service, Public Health England, London NW9 5EQ, UK; Tel: +44 20 8327 6707; E-mail: timo.smieszek@ 123456phe.gov.uk

          F. Christiaan K. Dolk and Koen B. Pouwels Contributed equally as first authors.

          Julie V. Robotham and Timo Smieszek Contributed equally as last authors.

          Article
          PMC5890730 PMC5890730 5890730 dkx504
          10.1093/jac/dkx504
          5890730
          29490062
          1af14fa2-c859-490f-9bba-219f1a91f953
          © Crown copyright 2018.

          Reproduced with the permission of the Controller of Her Majesty's Stationery Office/Queen's Printer for Scotland and Public Health England.

          History
          Page count
          Pages: 9
          Funding
          Funded by: NIH 10.13039/100000002
          Funded by: Public Health England 10.13039/501100002141
          Categories
          Supplement Papers

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