The prescription of antibiotics for general practitioners was the slowest in elderly patients and in those whose diagnosis is uncertain

English GPs prescribe fewer and fewer antibiotics and are choosing more and more drugs that target a limited number of organisms rather than broad-spectrum antibiotics, suggests a new study from King & # 39; s College London published online in BMJ Open.

However, decreases in GP prescribing rates have been lower in some patient groups, particularly patients older than 55 years and those for whom the diagnosis is unclear.

A global effort to reduce the use of antibiotics in response to the growing threat of antimicrobial resistance – a situation in which bacteria develop resistance to antibiotics, has therefore become more difficult to treat and perhaps ultimately impossible to treat.

The mechanism by which resistance develops is complex, but the more frequently antibiotics are used, the greater the number of bacteria exposed to them, and the more likely it is that antibiotic-sensitive bacteria will become resistant.

Antibiotic stewardship policies encouraging more thoughtful use of antibiotics have been introduced to slow the development of antimicrobial resistance. These policies encourage general practitioners to reduce the prescription of antibiotics as a whole and, when they need it, to choose an effective drug against a limited number of bacteria from a wide range of options, targeting a greater number of bacteria.

Xiaohui Sun, Ph.D. candidate of the Health Sciences of Population and Environment, who led the research of King's College London, badyzed the prescription of antibiotics with 102 general practitioners in England from 2014 to 2017 by extracting data from the UK Clinical Practice Research Datalink (CRPD).

The data showed that over this period the total antibiotic prescription decreased by 6.9% per year, from 608 prescriptions per 1,000 person-years in 2014 to 489 per 1,000 person-years in 2017 .

The prescribing rate of broad-spectrum beta-lactam antibiotics, which target a large number of organisms, has decreased more rapidly, by 9.3% per year, from 221 prescriptions per 1,000 person-years in 2014 to 163 per 1,000 person-years in 2017.

Prescription rates declined at a similar rate for both men and women, but were lower in older patients (over 55 years).

When the authors reviewed the diagnostic codes badociated with prescriptions, they found that prescribing rates decreased, especially for respiratory infections (9.8% per year), followed by genitourinary infections (5.7%), but had decreased by only 3.8% in cases where no medical reason for their prescription was recorded.

More than one third of the antibiotics (38.8%) prescribed by general practitioners were badociated with medical codes not indicating a clinical condition requiring their use, and 15.3% of antibiotic prescriptions contained no medical code. A large proportion of prescriptions not badociated with medical codes were repeat orders.

One of the potential limitations of the study is that not all prescriptions for antibiotics prescribed in the community may have been fully registered, the authors note, because prescriptions are made outside of the hours. Normal day work, day care and emergency care centers may not have been incorporated into electronic registration. . Prescription data from clinics and specialized hospitals were not included and these services may have issued prescriptions in the community.

On the other hand, the study examining the number of prescriptions written, and not the number of prescription antibiotics prescribed, it could not determine if the doctors GPs were using a deferred or delayed antibiotic prescription strategy. If this were the case, the consumption of antibiotics would be slightly lower than the prescription of antibiotics, the authors added.

One of the strengths of the study is that it examined the prescription habits of the same practices over four years. Sun concluded: "The prescription of antibiotics has decreased and has become more selective, but a large and unnecessary use of antibiotics may persist. The improvement of the quality of the diagnostic coding of the antibiotic is noticeable. use of antibiotics will help support antimicrobial management. "