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Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study
  1. Xiaohui Sun,
  2. Martin C Gulliford
  1. School of Population and Environmental Health Sciences, King’s College London, London, UK
  1. Correspondence to Xiaohui Sun; xiaohui.sun{at}


Objective To analyse individual-patient electronic health records to evaluate changes in antibiotic (AB) prescribing in England for different age groups, for male and female subjects, and by prescribing indications from 2014 to 2017.

Methods Data were analysed for 102 general practices in England that contributed data to the UK Clinical Practice Research Datalink (CPRD) from 2014 to 2017. Prescriptions for all ABs and for broad-spectrum β-lactam ABs were evaluated. Relative rate reductions (RRR) were estimated from a random-effects Poisson model, adjusting for age, gender, and general practice.

Results Total AB prescribing declined from 608 prescriptions per 1000 person-years in 2014 to 489 per 1000 person-years in 2017; RRR 6.9% (95% CI 6.6% to 7.1%) per year. Broad-spectrum β-lactam AB prescribing decreased from 221 per 1000 person-years in 2014 to 163 per 1000 person-years in 2017; RRR 9.3% (9.0% to 9.6%) per year. Declines in AB prescribing were similar for men and women but the rate of decline was lower over the age of 55 years than for younger patients. All AB prescribing declined by 9.8% (9.6% to 10.1%) per year for respiratory infections, 5.7% (5.2% to 6.2%) for genitourinary infections, but by 3.8% (3.1% to 4.5%) for no recorded indication. Overall, 38.8% of AB prescriptions were associated with codes that did not suggest specific clinical conditions, and 15.3% of AB prescriptions had no medical codes recorded.

Conclusion Antibiotic prescribing has reduced and become more selective but substantial unnecessary AB use may persist. Improving the quality of diagnostic coding for AB use will help to support antimicrobial stewardship efforts.

  • primary care
  • public health
  • respiratory infections
  • epidemiology

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  • Contributors MCG and XS conceived the study. XS analysed and interpreted the data, MCG contributed additional analysis. XS wrote the draft of the manuscript and both authors revised and approved the final draft. XS is the guarantor.

  • Funding XS is supported by the China Scholarship Council. MCG was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. This research is also supported by grants from the NIHR (HTA 13/88/10 and HS&DR 16/116/46).

  • Competing interests None declared.

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

  • Data sharing statement Clinical Practice ResearchDatalink data were analysed under licence and are not available for sharing.

  • Patient consent for publication Not required.

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