Dataset Information

Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study.

ABSTRACT:

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 ?-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 ?-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.

SUBMITTER: Sun X

PROVIDER: S-EPMC6661619 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Publications

Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study.

Sun Xiaohui X Gulliford Martin C MC

BMJ open 20190709 7

<h4>Objective</h4>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.<h4>Methods</h4>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 r ...[more]

PMID: 31289049

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Project description:BackgroundThe use of antidepressants in children and adolescents remains controversial. We examined trends over time and variation in antidepressant prescribing in children and young people in England and whether the drugs prescribed reflected UK licensing and guidelines.Methods and findingsQResearch is a primary care database containing anonymised healthcare records of over 32 million patients from more than 1,500 general practices across the UK. All eligible children and young people aged 5-17 years in 1998-2017 from QResearch were included. Incidence and prevalence rates of antidepressant prescriptions in each year were calculated overall, for 4 antidepressant classes (selective serotonin reuptake inhibitors [SSRIs], tricyclic and related antidepressants [TCAs], serotonin and norepinephrine reuptake inhibitors [SNRIs], and other antidepressants), and for individual drugs. Adjusted trends over time and differences by social deprivation, region, and ethnicity were examined using Poisson regression, taking clustering within general practitioner (GP) practices into account using multilevel modelling. Of the 4.3 million children and young people in the cohort, 49,434 (1.1%) were prescribed antidepressants for the first time during 20 million years of follow-up. Males made up 52.0% of the cohorts, but only 34.1% of those who were first prescribed an antidepressant in the study period. The largest proportion of the cohort was from London (24.4%), and whilst ethnicity information was missing for 39.5% of the cohort, of those with known ethnicity, 75.3% were White. Overall, SSRIs (62.6%) were the most commonly prescribed first antidepressant, followed by TCAs (35.7%). Incident antidepressant prescribing decreased in 5- to 11-year-olds from a peak of 0.9 in females and 1.6 in males in 1999 to less than 0.2 per 1,000 for both sexes in 2017, but incidence rates more than doubled in 12- to 17-year-olds between 2005 and 2017 to 9.7 (females) and 4.2 (males) per 1,000 person-years. The lowest prescription incidence rates were in London, and the highest were in the South East of England (excluding London) for all sex and age groups. Those living in more deprived areas were more likely to be prescribed antidepressants after adjusting for region. The strongest trend was seen in 12- to 17-year-old females (adjusted incidence rate ratio [aIRR] 1.12, 95% confidence interval [95% CI] 1.11-1.13, p < 0.001, per deprivation quintile increase). Prescribing rates were highest in White and lowest in Black adolescents (aIRR 0.32, 95% CI 0.29-0.36, p < 0.001 [females]; aIRR 0.32, 95% CI 0.27-0.38, p < 0.001 [males]). The 5 most commonly prescribed antidepressants were either licensed in the UK for use in children and young people (CYP) or included in national guidelines. Limitations of the study are that, because we did not have access to secondary care prescribing information, we may be underestimating the prevalence and misidentifying the first antidepressant prescription. We could not assess whether antidepressants were dispensed or taken.ConclusionsOur analysis provides evidence of a continuing rise of antidepressant prescribing in adolescents aged 12-17 years since 2005, driven by SSRI prescriptions, but a decrease in children aged 5-11 years. The variation in prescribing by deprivation, region, and ethnicity could represent inequities. Future research should examine whether prescribing trends and variation are due to true differences in need and risk factors, access to diagnosis or treatment, prescribing behaviour, or young people's help-seeking behaviour.

Project description:BackgroundResearch has questioned the safety of delaying or withholding antibiotics for suspected urinary tract infection (UTI) in older patients. We evaluated the association between antibiotic treatment for lower UTI and risk of bloodstream infection (BSI) in adults aged ≥65 years in primary care.Methods and findingsWe analyzed primary care records from patients aged ≥65 years in England with community-onset UTI using the Clinical Practice Research Datalink (2007-2015) linked to Hospital Episode Statistics and census data. The primary outcome was BSI within 60 days, comparing patients treated immediately with antibiotics and those not treated immediately. Crude and adjusted associations between exposure and outcome were estimated using generalized estimating equations. A total of 147,334 patients were included representing 280,462 episodes of lower UTI. BSI occurred in 0.4% (1,025/244,963) of UTI episodes with immediate antibiotics versus 0.6% (228/35,499) of episodes without immediate antibiotics. After adjusting for patient demographics, year of consultation, comorbidities, smoking status, recent hospitalizations, recent accident and emergency (A&E) attendances, recent antibiotic prescribing, and home visits, the odds of BSI were equivalent in patients who were not treated with antibiotics immediately and those who were treated on the date of their UTI consultation (adjusted odds ratio [aOR] 1.13, 95% CI 0.97-1.32, p-value = 0.105). Delaying or withholding antibiotics was associated with increased odds of death in the subsequent 60 days (aOR 1.17, 95% CI 1.09-1.26, p-value < 0.001), but there was limited evidence that increased deaths were attributable to urinary-source BSI. Limitations include overlap between the categories of immediate and delayed antibiotic prescribing, residual confounding underlying differences between patients who were/were not treated with antibiotics, and lack of microbiological diagnosis for BSI.ConclusionsIn this study, we observed that delaying or withholding antibiotics in older adults with suspected UTI did not increase patients' risk of BSI, in contrast with a previous study that analyzed the same dataset, but mortality was increased. Our findings highlight uncertainty around the risks of delaying or withholding antibiotic treatment, which is exacerbated by systematic differences between patients who were and were not treated immediately with antibiotics. Overall, our findings emphasize the need for improved diagnostic/risk prediction strategies to guide antibiotic prescribing for suspected UTI in older adults.

Dataset Information

Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study.

Objective

Methods

Results

Conclusion

Publications

Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study.

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