To examine variations across general practices and factors associated with antibiotic prescribing for common infections in UK primary care to identify potential targets for improvement and optimization of prescribing.
Oral antibiotic prescribing for common infections was analysed using anonymized UK primary care electronic health records between 2000 and 2015 using the Clinical Practice Research Datalink (CPRD). The rate of prescribing for each condition was observed over time and mean change points were compared with national guideline updates. Any correlation between the rate of prescribing for each infectious condition was estimated within a practice. Predictors of prescribing were estimated using logistic regression in a matched patient cohort (1:1 by age, sex and calendar time).
Over 8 million patient records were examined in 587 UK general practices. Practices varied considerably in their propensity to prescribe antibiotics and this variance increased over time. Change points in prescribing did not reflect updates to national guidelines. Prescribing levels within practices were not consistent for different infectious conditions. A history of antibiotic use significantly increased the risk of receiving a subsequent antibiotic (by 22%–48% for patients with three or more antibiotic prescriptions in the past 12months), as did higher BMI, history of smoking and flu vaccinations. Other drivers for receiving an antibiotic varied considerably for each condition.
Large variability in antibiotic prescribing between practices and within practices was observed. Prescribing guidelines alone do not positively influence a change in prescribing, suggesting more targeted interventions are required to optimize antibiotic prescribing in the UK.
Victoria Palin, Anna Molter, Darren M Ashcroft, Andrew White, William Welfare, Tjeerd van Staa, Antibiotic prescribing for common infections in UK general practice variability and drivers. Journal of Antimicrobial Chemotherapy, 74:2440-2450, 2019.
|Code||Description||Entity type||Category||Coding System (Read)|
|H01..00||Acute sinusitis||res70: Sinusitis||diagnostic||Read|
|H010.00||Acute maxillary sinusitis||res70: Sinusitis||diagnostic||Read|
|H011.00||Acute frontal sinusitis||res70: Sinusitis||diagnostic||Read|
|H012.00||Acute ethmoidal sinusitis||res70: Sinusitis||diagnostic||Read|
|H013.00||Acute sphenoidal sinusitis||res70: Sinusitis||diagnostic||Read|
|H014.00||Acute rhinosinusitis||res70: Sinusitis||diagnostic||Read|
|H01y.00||Other acute sinusitis||res70: Sinusitis||diagnostic||Read|
|H01yz00||Other acute sinusitis NOS||res70: Sinusitis||diagnostic||Read|
|H01z.00||Acute sinusitis NOS||res70: Sinusitis||diagnostic||Read|
|H13..00||Chronic sinusitis||res70: Sinusitis||diagnostic||Read|
|H13..11||Chronic rhinosinusitis||res70: Sinusitis||diagnostic||Read|
|H130.00||Chronic maxillary sinusitis||res70: Sinusitis||diagnostic||Read|
|H130.11||Antritis - chronic||res70: Sinusitis||diagnostic||Read|
|H130.12||Maxillary sinusitis||res70: Sinusitis||diagnostic||Read|
|H131.00||Chronic frontal sinusitis||res70: Sinusitis||diagnostic||Read|
|H131.11||Frontal sinusitis||res70: Sinusitis||diagnostic||Read|
|H132.00||Chronic ethmoidal sinusitis||res70: Sinusitis||diagnostic||Read|
|H134.00||Fistula of nasal sinus||res70: Sinusitis||diagnostic||Read|
|H135.00||Recurrent sinusitis||res70: Sinusitis||diagnostic||Read|
|H13y.00||Other chronic sinusitis||res70: Sinusitis||diagnostic||Read|
|H13y000||Chronic pansinusitis||res70: Sinusitis||diagnostic||Read|
|H13yz00||Other chronic sinusitis NOS||res70: Sinusitis||diagnostic||Read|
|H13z.00||Chronic sinusitis NOS||res70: Sinusitis||diagnostic||Read|
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