title: Trends in antibiotic prescribing in primary care for clinical syndromes subject to national recommendations to reduce antibiotic resistance, UK 1995-2011: analysis of a large database of primary care consultations.
abstract: OBJECTIVE
  To measure trends in antibiotic prescribing in UK primary care in relation to nationally recommended best practice.
  
  
  METHODS
  A descriptive study linking individual patient data on diagnosis and prescription in a large primary care database, covering 537 UK general practices during 1995-2011.
  
  
  RESULTS
  The proportion of cough/cold episodes for which antibiotics were prescribed decreased from 47% in 1995 to 36% in 1999, before increasing to 51% in 2011. There was marked variation by primary care practice in 2011 [10th-90th percentile range (TNPR) 32%-65%]. Antibiotic prescribing for sore throats fell from 77% in 1995 to 62% in 1999 and then stayed broadly stable (TNPR 45%-78%). Where antibiotics were prescribed for sore throat, recommended antibiotics were used in 69% of cases in 2011 (64% in 1995). The use of recommended short-course trimethoprim for urinary tract infection (UTI) in women aged 16-74 years increased from 8% in 1995 to 50% in 2011; however, a quarter of practices prescribed short courses in ≤16% of episodes in 2011. For otitis media, 85% of prescriptions were for recommended antibiotics in 2011, increasing from 77% in 1995. All these changes in annual prescribing were highly statistically significant (P < 0.001).
  
  
  CONCLUSIONS
  The implementation of national guidelines in UK primary care has had mixed success, with prescribing for coughs/colds, both in total and as a proportion of consultations, now being greater than before recommendations were made to reduce it. Extensive variation by practice suggests that there is significant scope to improve prescribing, particularly for coughs/colds and for UTIs.
authors.affiliation: Field Epidemiology Service, Public Health England, 5 St Philip's Place, Birmingham B3 2PW, UK jeremy.hawker@phe.gov.uk.
authors.forename: Jeremy I
authors.initials: JI
authors.lastname: Hawker
authors.affiliation: Real-time Syndromic Surveillance Team, Public Health England, 5 St Philip's Place, Birmingham B3 2PW, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Smith
authors.affiliation: Real-time Syndromic Surveillance Team, Public Health England, 5 St Philip's Place, Birmingham B3 2PW, UK.
authors.forename: Gillian E
authors.initials: GE
authors.lastname: Smith
authors.affiliation: Real-time Syndromic Surveillance Team, Public Health England, 5 St Philip's Place, Birmingham B3 2PW, UK.
authors.forename: Roger
authors.initials: R
authors.lastname: Morbey
authors.affiliation: Department of Healthcare Associated Infection and Antimicrobial Resistance, Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
authors.forename: Alan P
authors.initials: AP
authors.lastname: Johnson
authors.affiliation: Royal College of General Practitioners Research and Surveillance Centre, Birmingham B17 9DB, UK.
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Fleming
authors.affiliation: Department of Infection and Population Health, University College London, London NW3 4PQ, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Shallcross
authors.affiliation: Department of Infection and Population Health, University College London, London NW3 4PQ, UK.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Hayward
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000592:standards*; D004358:Drug Therapy / Q000592:standards; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006291:Health Policy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D006113:United Kingdom; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic prescribing; otitis media; primary care; respiratory tract infections; surveillance trends; urinary tract infections