A third of antibiotic prescriptions 'lack documented justification'

Of the 4.6 million antibiotic prescriptions issued by primary care in England between 2013 and 2015, 31% were not linked to a recorded clinical condition, research by Public Health England has shown.

Variation in antibiotic prescribing rates between practices suggests there is potential to further reduce prescribing in at least some practices. | iStock
Variation in antibiotic prescribing rates between practices suggests there is potential to further reduce prescribing in at least some practices. | iStock

Analysis of primary care data from The Health Improvement Network (THIN) database showed that 4.57 million antibiotic prescriptions were issued between 2013 and 2015. Of these, only 69% were associated with a documented clinical condition.

The research features in a supplement to the Journal of Antimicrobial Chemotherapy examining inappropriate prescribing of antibiotics in primary care.

The prescribing rate varied considerably among participating practices, with a median of 626 prescriptions/1000 patients (IQR 543–699).

Another paper in the supplement showed that the majority of this variation cannot be explained by differences between practices in the prevalence of comorbidities. Rather, it is likely to be caused by factors such as high consultation rates for respiratory tract infections and high prescribing rates for corticosteroids.

Inappropriate prescribing

Consistent with the apparent lack of clinical justification for some antibiotic prescriptions, related research found that antibiotics were prescribed significantly more often for most conditions than recommended by expert opinion.

An antibiotic was prescribed in 41% of all uncomplicated acute cough consultations when experts advocate 10%. Similar findings were noted for bronchitis (82% vs 13%), sore throat (59% vs 13%), rhinosinusitis (88% vs 11%) and acute otitis media in two- to 18-year-olds (92% vs 17%).

A further study sought to quantify inappropriate antibiotic prescribing.

Applying the most conservative assumptions, the researchers found that 8.8% of all systemic antibiotic prescriptions in English primary care would be considered inappropriate, and in the least conservative scenario 23.1% of prescriptions were inappropriate.

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%).

Collectively the research 'suggest[s] the existence of substantial (albeit with large uncertainty) inappropriate antibiotic prescribing, indicating there is clear scope for improvement,' say the authors of a preface to the supplement.

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