A new report from Public Health England (PHE) found that between 2010 and 2013 there was a 6% increase in the combined antibiotic prescribing of GPs and hospitals. There was also an increase of 12% in the number of bloodstream infections caused by E.coli with varying levels of resistance to key antibiotics for this infection of between 10 to 19%.
These data are from the first annual report of PHE’s English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR), published today (10 October 2014).
While the proportion of resistant infections remains the same as that seen in previous years, as the total number of infections has increased so the total number of resistant infections has risen. The report also shows a wide variation in both prescribing habits and antibiotic usage across England.
- between 2010 and 2013 total antibiotic consumption (GPs and hospitals) rose by 6% from 25.9 to 27.4 daily defined dose* per 1,000 inhabitants per day
- over the same 4-year period GP prescribing rose by 4%, prescribing to hospital inpatients rose by 12% and other community prescriptions (dentists and other non-GP prescribing) rose by 32%. This latter area is of concern and needs to be further examined
- the increasing number of E.coli bloodstream infections has seen a corresponding increase in levels of resistance to a number of key antibiotics
- higher rates of resistance were seen in those areas with higher rates of prescribing
- there was a difference in prescribing between the north and south of the country. This is an area that needs more investigation but some of the differences may be due to deprivation, higher rates of smoking, co-morbidities, and other factors
- the highest levels of GP prescribing were seen in Durham, Darlington and Tees which was over 40% higher than London (26.5 versus 18.9 daily defined dose per 1,000 inhabitants). However, this may be due to access to healthcare in London (with people attending hospitals instead of GP practices to access treatment), as London has the highest amount of hospital prescribing per population
Lead author Dr Susan Hopkins, a healthcare epidemiologist at PHE, said:
This publication marks a real move forward in our understanding of antibiotic prescribing habits as it is the first time that both GP and hospital prescribing data have been collated in one document and prescribing trends analysed.
The aim now must be to reduce levels of prescribing back to that seen in 2010. There are already a number of different activities going ahead to support this including the development of quality measures for prescribing. This will enable local clinical commissioning groups to monitor the prescribing of hospitals and surgeries in their area and see how they compare against a benchmark. They will also be responsible for taking action against inappropriate prescribing in their area.
In addressing the issue of antibiotic resistance it is important to look at the whole healthcare economy approach. There is a lot of work going on to address the problem of antibiotic resistance but we must not underestimate how much work needs to be done to turn the tide and get levels of resistance down.
Professor John Watson, deputy chief medical officer at the Department of Health, said:
Antimicrobial resistance is one of the biggest threats to health security facing the world today and everybody must take action. We want to support all doctors and other prescribers in reducing their prescribing rates where possible. These data will play an important part in highlighting regional variations in prescribing.
Professor Anthony Kessel, director of international public health at PHE, said:
We cannot underestimate the importance of this report. Antibiotic resistance is one of the biggest threats of our time and understanding more about who is prescribing and what is being prescribed is the first step to helping us make improvements.
In England we are progressing and implementing a raft of tools to help us reduce the levels of prescribing and resistance and these include benchmarking, accountability on prescribing and quality measures. We are also asking everyone in the UK, the public and the medical community, to join our campaign and become an Antibiotic Guardian. We want everyone to choose one simple pledge about how they make better use of antibiotics and help save these vital medicines from becoming obsolete.
ESPAUR was established as a response to the UK cross government 5-year strategy to address the growing problem of antibiotic resistance. The report focuses on the use of antibiotics, stewardship and levels of resistance by NHS area team across GP practices and hospitals (primary and secondary care).
Notes to editors
Read the PHE English surveillance programme antimicrobial utilisation and resistance report.
- Both the primary and secondary care data is expressed as a defined daily dose (DDD) which is an internationally recognised unit of measurement of medicine consumption recommended by the WHO.
- The highest combined GP and hospital prescribing was in Merseyside (30.4 DDD per 1,000 inhabitants). Although rates of prescribing were higher in this area there were more narrow-spectrum antibiotics prescribed which are the preferred choices, wherever possible.
- The area with the lowest combined prescribing was in the Thames Valley with 22.8 DDD per 1,000 inhabitants per day).
- Consumption rates at a national and Area Team level were calculated using 2010 to 2011 and 2012 mid-year resident population estimates based on the 2011 census for England. 2013 consumption rates are based on 2012 mid-year population estimates.
- From 2010 to 2013 hospital admissions rose by 2.4% and bed-days declined by 1.3%. This suggests that there was increased activity but earlier discharge from hospital.
GP prescribing rose by 4.1% between 2010 and 2013 from 20.6 to 21.5 DDD per 1,000 inhabitants each day. Prescribing to hospital inpatients rose by 12% from 2.3 to 2.5 DDD per 1,000 inhabitants per day over the same period and community prescribing rose by 32% from 1.3 to 1.7 DDD per 1,000 inhabitants per day.
- Between 2010 and 2013 the predominant antibiotics in use in England were penicillins, tetracyclines and macrolides.
- In terms of the totality of prescribing in 2013, 66 different antibiotics were prescribed with the top 15 agents accounting for 98% and 88% of GP and hospital consumption respectively.
- E.coli - between 2010 and 2013 resistance to an antibiotic called ciprofloxacin increased 18% (3,654 to 4,321) and resistance to cephalosporins and gentamicin rose 28 and 27% respectively.
- Use of tetracyclines has risen significantly between 2010 and 2013 in both GP practices and in hospitals in all Area Teams. The DDD has risen from 3.9 to 4.5 per 1,000 inhabitants per day in GP practices and hospitals from 0.18 to 0.21 per 1,000 inhabitants per day.
- You can make your pledges on the Antibiotic Guardian website
- Public Health England’s mission is to protect and improve the nation’s health and to address inequalities through working with national and local government, the NHS, industry and the voluntary and community sector. PHE is an operationally autonomous executive agency of the Department of Health.