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Understanding the gender gap in antibiotic prescribing: a cross-sectional analysis of English primary care
  1. David R M Smith1,
  2. F Christiaan K Dolk1,2,
  3. Timo Smieszek1,3,
  4. Julie V Robotham1,
  5. Koen B Pouwels1,2,3
  1. 1 Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
  2. 2 PharmacoTherapy, Epidemiology & Economics, Department of Pharmacy, University of Groningen, Groningen, Netherlands
  3. 3 Department of Infectious Disease Epidemiology, MRC Centre for Outbreak Analysis and Modelling, Imperial College School of Public Health, London, UK
  1. Correspondence to Mr David R M Smith; David.R.M.Smith{at}


Objectives To explore the causes of the gender gap in antibiotic prescribing, and to determine whether women are more likely than men to receive an antibiotic prescription per consultation.

Design Cross-sectional analysis of routinely collected electronic medical records from The Health Improvement Network (THIN).

Setting English primary care.

Participants Patients who consulted general practices registered with THIN between 2013 and 2015.

Primary and secondary outcome measures Total antibiotic prescribing was measured in children (<19 years), adults (19–64 years) and the elderly (65+ years). For 12 common conditions, the number of adult consultations was measured, and the relative risk (RR) of being prescribed antibiotics when consulting as female or with comorbidity was estimated.

Results Among 4.57 million antibiotic prescriptions observed in the data, female patients received 67% more prescriptions than male patients, and 43% more when excluding antibiotics used to treat urinary tract infection (UTI). These gaps were more pronounced in adult women (99% more prescriptions than men; 69% more when excluding UTI) than in children (9%; 0%) or the elderly (67%; 38%). Among adults, women accounted for 64% of consultations (62% among patients with comorbidity), but were not substantially more likely than men to receive an antibiotic prescription when consulting with common conditions such as cough (RR 1.01; 95% CI 1.00 to 1.02), sore throat (RR 1.01, 95% CI 1.00 to 1.01) and lower respiratory tract infection (RR 1.00, 95% CI 1.00 to 1.01). Exceptions were skin conditions: women were less likely to be prescribed antibiotics when consulting with acne (RR 0.67, 95% CI 0.66 to 0.69) or impetigo (RR 0.85, 95% CI 0.81 to 0.88).

Conclusions The gender gap in antibiotic prescribing can largely be explained by consultation behaviour. Although in most cases adult men and women are equally likely to be prescribed an antibiotic when consulting primary care, it is unclear whether or not they are equally indicated for antibiotic therapy.

  • antibacterial agents
  • prescriptions
  • electronic health records
  • antibiotic prescribing
  • consultation
  • gender bias

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  • DRMS and FCKD contributed equally.

  • Contributors DRMS and KBP conceived and designed the study. KBP extracted the data from The Health Improvement Network database. FCKD and KBP conducted the analyses. DRMS, JVR, KBP and TS carried out the interpretation of data. DRMS drafted the manuscript. FCKD, JVR, KBP and TS critically revised the manuscript for important intellectual content. All authors approved the final version prior to submission.

  • Funding This work was funded internally by Public Health England.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study received approval from THIN’s Scientific Review Committee (reference number 16THIN-071-A2).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement This analysis is based on a large sample from The Health Improvement Network, provided by IMS Health. The authors’ licence for using these data precludes the sharing of raw data with third parties.

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