A report from Public Health England (English surveillance programme for antimicrobial utilisation and resistance (ESPAUR)) published on 10th October found that between 2010 and 2013 there was a 5% increase in the combined antibiotic prescribing of GPs and hospitals. There was also an increase of 12% in the number of bloodstream infections caused by E.coli with varying levels of resistance to key antibiotics for this infection of between 10 and 19%.
In general, higher rates of resistance were seen in regions with higher rates of prescribing. The highest levels of GP prescribing were seen in Durham, Darlington and Tees, which were over 40% higher than London (26.5 versus 18.9 defined daily doses per 1000 inhabitants), however the report acknowledged this may be due to access to healthcare in London.
Key findings from the report
- Between 2010 and 2013 total antibiotic use (including both GPs and hospitals) went up by 6% – from 25.9 to 27.4 daily defined dose (DDR*) per 1,000 inhabitants per day
- GP prescribing rose by 4.1%, from 20.6 to 21.55 DDD per 1,000 inhabitants per day
- Prescribing to hospital inpatients rose by 12%, from 2.3 to 2.5 DDD per 1,000 inhabitants per day
- Community prescribing (dentists and other non-GPs) rose by 32%, from 1.3 to 1.7 DDD per 1,000 inhabitants per day
- Predominant antibiotics in use were penicillins, tetracyclines and macrolides
- Resistance to cephalosporins and gentamicin rose by 28% and 27%, respectively
- Use of tetracyclines has risen significantly in both GP practices and hospitals, from 3.9 to 4.5 DDD per 1,000 inhabitants, and from 0.18 to 0.21 DDD per 1,000 inhabitants, respectively
What is being done nationally?
From April data on GP practice-level prescribing of antibiotics will be published by PHE, so that people can see at ‘a click of a button’ how each compares with other practices in the CCG, area team and nationally. Data on each individual GP’s level of antibiotic prescribing will also be added in future
This will mean ‘organisations can interrogate the key resistance and consumption measures in one platform’.
What is being done locally in the North East and Cumbria?
A regional primary care antibiotic guideline will be launched in early 2015 to support primary care prescribers with their antibiotic prescribing. The NECS Medicines Optimisation Team are also working with local CCGs and FTs to produce a range of resources to support prescribers with the decision making process around antibiotics, including an eLearning programme, patient decision aids and ‘Keep Calm, antibiotics aren’t always the answer’ campaign posters and leaflets.