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Potential for reducing inappropriate antibiotic prescribing in English primary care.

Smieszek, T; Pouwels, KB; Dolk, FCK; Smith, DRM; Hopkins, S; Sharland, M; Hay, AD; Moore, MV; Robotham, JV (2018) Potential for reducing inappropriate antibiotic prescribing in English primary care. J Antimicrob Chemother, 73 (suppl_2). ii36-ii43. ISSN 1460-2091 https://doi.org/10.1093/jac/dkx500
SGUL Authors: Sharland, Michael Roy

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Abstract

Objectives: To identify and quantify inappropriate systemic antibiotic prescribing in primary care in England, and ultimately to determine the potential for reduction in prescribing of antibiotics. Methods: Primary care data from 2013-15 recorded in The Health Improvement Network (THIN) database were used. Potentially inappropriate prescribing events in the database were identified by: (i) comparing prescribing events against treatment guidelines; (ii) comparing actual proportions of consultations resulting in prescription for a set of conditions with the ideal proportions derived from expert opinion; and (iii) identifying high prescribers and their number of prescriptions above an age- and body-system-specific benchmark. Results: Applying the most conservative assumptions, 8.8% of all systemic antibiotic prescriptions in English primary care were identified as inappropriate, and in the least conservative scenario 23.1% of prescriptions were inappropriate. All practices had non-zero reduction potentials, ranging from 6.4% to 43.5% in the middle scenario. The four conditions that contributed most to inappropriate prescribing were sore throat (23.0% of identified inappropriate prescriptions), cough (22.2%), sinusitis (7.6%) and acute otitis media (5.7%). One-third of all antibiotic prescriptions lacked an informative diagnostic code. Conclusions: This work demonstrates (i) the existence of substantial inappropriate antibiotic prescribing and (ii) poor diagnostic coding in English primary care. All practices (not just the high prescribers) should engage in efforts to improve antimicrobial stewardship. Better diagnostic coding, more precise prescribing guidelines and a deeper understanding of appropriate long-term uses of antibiotics would allow identification of further potential for reductions.

Item Type: Article
Additional Information: © Crown copyright 2018.
Keywords: 1115 Pharmacology And Pharmaceutical Sciences, 0605 Microbiology, 1108 Medical Microbiology, Microbiology
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: J Antimicrob Chemother
ISSN: 1460-2091
Language: eng
Dates:
DateEvent
1 February 2018Published
27 February 2018Published Online
10 January 2018Accepted
Publisher License: Publisher's own licence
PubMed ID: 29490058
Web of Science ID: WOS:000426846800006
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/109849
Publisher's version: https://doi.org/10.1093/jac/dkx500

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