title: Containing antibiotic resistance: decreased antibiotic-resistant coliform urinary tract infections with reduction in antibiotic prescribing by general practices.
abstract: BACKGROUND
  GPs are urged to prescribe antibiotics less frequently, despite lack of evidence linking reduced antibiotic prescribing with reductions in resistance at a local level.
  
  
  OBJECTIVE
  To investigate associations between changes in antibiotic dispensing and changes in antibiotic resistance at general-practice level.
  
  
  METHODS
  Seven-year study of dispensed antibiotics and antibiotic resistance in coliform isolates from urine samples routinely submitted from general practice.
  
  
  METHODS
  General practices in Wales.
  
  
  METHODS
  Multilevel modelling of trends in resistance to ampicillin and trimethoprim, and changes in practice total antibiotic dispensing and amoxicillin and trimethoprim dispensing.
  
  
  RESULTS
  The primary analysis included data on 164 225 coliform isolates from urine samples submitted from 240 general practices over the 7-year study period. These practices served a population of 1.7 million patients. The quartile of practices that had the greatest decrease in total antibiotic dispensing demonstrated a 5.2% reduction in ampicillin resistance over the 7-year period with changes of 0.4%, 2.4%, and -0.3% in the other three quartiles. There was a statistically significant overall decrease in ampicillin resistance of 1.03% (95% confidence interval [CI] = 0.37 to 1.67%) per decrease of 50 amoxicillin items dispensed per 1000 patients per annum. There were also significant reductions in trimethoprim resistance in the two quartiles of practices that reduced total antibiotic dispensing most compared with those that reduced it least, with an overall decrease in trimethoprim resistance of 1.08% (95% CI = 0.065 to 2.10%) per decrease of 20 trimethoprim items dispensed per 1000 patients per annum. Main findings were confirmed by secondary analyses of 256 370 isolates from 527 practices that contributed data at some point during the study period.
  
  
  CONCLUSIONS
  Reducing antibiotic dispensing at general-practice level is associated with reduced local antibiotic resistance. These findings should further encourage clinicians and patients to use antibiotics conservatively.
authors.affiliation: Department of Primary Care and Public Health, Cardiff University, Centre for Health Sciences Research, School of Medicine, Cardiff, Wales. butlercc@cf.ac.uk
authors.forename: Chris C
authors.initials: CC
authors.lastname: Butler
authors.forename: Frank
authors.initials: F
authors.lastname: Dunstan
authors.forename: Margaret
authors.initials: M
authors.lastname: Heginbothom
authors.forename: Brendan
authors.initials: B
authors.lastname: Mason
authors.forename: Zoë
authors.initials: Z
authors.lastname: Roberts
authors.forename: Sharon
authors.initials: S
authors.lastname: Hillier
authors.forename: Robin
authors.initials: R
authors.lastname: Howe
authors.forename: Stephen
authors.initials: S
authors.lastname: Palmer
authors.forename: Anthony
authors.initials: A
authors.lastname: Howard
mesh_terms: D000658:Amoxicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000892:Anti-Infective Agents, Urinary / Q000008:administration & dosage; D011307:Drug Prescriptions; D004352:Drug Resistance, Microbial; D005194:Family Practice; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000639:trends*; D014295:Trimethoprim / Q000008:administration & dosage; D014296:Trimethoprim Resistance; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology / Q000652:urine; D014852:Wales
chemical_list: D000900:Anti-Bacterial Agents; D000892:Anti-Infective Agents, Urinary; D000658:Amoxicillin; D014295:Trimethoprim