Antibiotic prescriptions fall for the first time in England
According to a report from the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) on behalf of Public Health England (PHE), antibiotic prescribing has fallen for the first time in England. Between 2014 and 2015, total antibiotic consumption declined from approximately 23 to 22 defined daily doses (DDD) per 100 inhabitants per day; a 4 per cent reduction.
ESPAUR was established by PHE in 2013, in response to the UK Five-year Antimicrobial Resistance Strategy, with the aim to gather and disseminate data relevant to antimicrobial use, resistance and stewardship. The ESPAUR report says that this is the first time a reduction in antibiotic use has been seen across the whole healthcare system. This reflects improved antimicrobial stewardship in general practice, hospitals and dental practices, which together account for 97 per cent of antibiotic prescribing. In particular, antibiotic prescribing in primary care has declined over the last four years and is now lower than in 2011 (from 1.23 items per Specific Therapeutic group Age-sex Related Prescribing Units (STAR-PU) in 2011 to 1.11 items per STAR-PU in 2015). Broad-spectrum antibiotic prescribing also continues to decrease in primary care, and England now uses the lowest volume of cephalosporins and quinolones in the EU. However, antimicrobial stewardship in community settings, which accounts for 3 per cent of all antibiotic prescribing, still requires improvement.
Despite these improvements, ESPAUR warns that some antibiotic-resistant infections, including bloodstream infections caused by Escherichia coli, Klebsiella pneumoniae and Enterococcus spp., continue to rise in England. However, antimicrobial resistance in Staphylococcus aureus infections is declining and resistance in pneumococcal and Pseudomonas bloodstream infections is stable.
Meanwhile, NICE is currently consulting on draft guidance on managing common infections. The guidance, which is intended for prescribers, commissioners and the public, aims to provide evidence-based advice on how common infections can be managed, with the aim of tackling antimicrobial resistance.