ESPAUR report shows continuing decline in primary care antibiotic prescribing

The English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) has published its fifth annual report on antimicrobial resistance and prescribing trends up to the end of 2017. ESPAUR was established in 2013 to support Public Health England in its delivery of the UK Five Year Antimicrobial Resistance Strategy.

The latest report shows that the proportion of bacterial species causing bloodstream infections resistant to key antibiotics has remained stable over the last five years. ESPAUR says that this likely reflects the success of antimicrobial stewardship activities, which has reduced the levels of antibiotic prescribing in England. However, the burden of resistance measured in terms of total numbers of antibiotic-resistant bloodstream infections has increased by over third between 2013 and 2017, as a result of an increased incidence of bloodstream infections overall.

There was a 22% increase in reported diagnoses of gonorrhoea between 2016 and 2017 in England. No isolates of Neisseria gonorrhoeae were resistant to ceftriaxone but 9.2% were resistant to azithromycin in 2017. In the same year, 5102 people were given a diagnosis of tuberculosis in England, with 8.5% showing resistance to at least one first-line antibiotic and 1.8% having multidrug-resistant/rifamipicin-resistant tuberculosis (compared with 1.7% in 2016).

Antibiotic consumption in England fell by 6.1% between 2014 (a 20-year peak) and 2017. The most commonly used antibiotics in 2017 continue to be penicillins, tetracyclines and macrolides, and primary care settings accounted for 81% of all antibiotics prescribed. However, the number of antibiotic prescriptions dispensed in primary care has declined by 13.2% over the past five years, from 754 per 1000 population in 2013 to 654 per 1000 in 2017. Conversely, overall antibiotic consumption in secondary care increased by 7.7% between 2013 and 2017, largely as a result of increased prescribing in hospital outpatient settings.

Meanwhile, Public Health England has relaunched its Keep Antibiotics Working campaign to support the government’s efforts to reduce inappropriate antibiotic prescribing. The campaign, which aims to educate the public about the risks of antibiotic resistance and encourage them to take healthcare professionals’ advice on the need for antibiotics, includes social media toolkits, posters, leaflets, plus TV, radio and newspaper advertisements. 

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