A new report from Public Health England (PHE) shows that for the first time fewer antibiotics are being prescribed by GPs and clinicians. A decline in the use of antibiotics has occurred across all healthcare settings, including in the community and hospitals. This is the first time a reduction has been seen in antibiotic use across the whole healthcare system.
Safely reducing the amount of antibiotics that are inappropriately prescribed is a vital part of the work to tackle antibiotic resistance. In 2015, 2.2 million fewer antibiotic prescriptions were dispensed in the community compared to 2014. This equates to 6% of all prescriptions.
Use of broad-spectrum antibiotics (which are effective against a wide range of bacteria and more likely to lead to resistance) has also decreased in primary care for the second year running.
Dr Susan Hopkins, lead author and healthcare epidemiologist at PHE, said:
The overall decrease in the number of antibiotics being prescribed is great news but we can’t become complacent; there is still a lot of work to be done.
PHE is responsible for enabling better access to and use of surveillance data on antimicrobial resistance; we hope today’s report will help doctors, clinicians and wider healthcare professionals understand and measure what is happening in their area and develop local action plans to tackle antimicrobial resistance.
Professor Dame Sally Davies, Chief Medical Officer said:
Antimicrobial resistance is the biggest threat to global health - it could halt the progress of over a century of modern medicine. Before antibiotics and vaccines, around 40% of all deaths were due to infections, now it is just 7%. We do not want to see this reversed so we must do all we can to fight drug resistant infections.
Reducing inappropriate antibiotic prescribing is a key element in the fight against drug resistant infections and I am really pleased to see staff across the entire NHS making positive changes. We all have a role to play, and preventing infection through good hygiene and not demanding antibiotics when they are not clinically justified are just two of the ways we can help.
Dr Mike Durkin, NHS National Director of Patient Safety, said:
These results are a fantastic step in the right direction in the fight against antimicrobial resistance and are testament to the huge efforts of healthcare staff and local commissioners across the country, who must be congratulated for this achievement.
To help continue this trend we are working with our partners to introduce new national incentive schemes for 2017/19 that will further support healthcare providers and commissioners to ensure antibiotics are used responsibly and appropriately, and further prevent the infections that require antibiotic treatments. We are fully committed to supporting the NHS to meet the government’s antimicrobial resistance ambitions of reducing both gram-negative bacteraemia and inappropriate prescribing by 50% by 2020.
Professor Gillian Leng, deputy chief executive at NICE said:
Establishing better ways of using our current antibiotics is vital, and this is being informed by new NICE guidance on managing common infections.
We will also be producing prescribing summaries for all new antimicrobials, with advice on how they should be used in practice. This will require close links to the PHE resistance data, to ensure new antimicrobials are used only when necessary.
The new data published today by PHE shows that our attitudes are changing for the better. Now we must work hard to maintain this momentum – new NICE advice will help protect new antimicrobials for future generations.
Although we have seen significant reductions in prescribing of antibiotics there is no room for complacency as antibiotic resistant infections have continued to increase.
Between 2010 and 2014 bloodstream infections caused by Escherichia coli (E.coli) and Klebsiella pneumoniae (K. pneumoniae) increased by 15.6% and 20.8% respectively. In 2015 further increases were seen; E. coli by 4.6% and K. pneumoniae by 9%.
The number of E. coli bloodstream infections that were resistant to antibiotics also increased, with infections resistant to third-generation cephalosporins increasing by 11% (to just over 4,600) between 2014 and 2015, and infections resistant to ciprofloxacin increasing by 5.2% (to almost 7,000).
Clinicians and prescribers should continue improving infection prevention strategies, updating treatment guidelines and developing local action plans for infection prevention and control.
The rise in infections over 2015 is in line with increases we have seen over the past 5 years, highlighting that more work is needed to tackle antimicrobial resistance.
We recognise that this increase needs further action and reducing E. coli bloodstream infections is a key 2 years.
Other key findings in the report include:
- resistance to carbapenems, a group of ‘last resort antibiotics’, remains low in bloodstream infections in England
- there is wide variation in the rates of resistance to antibiotics across England
- antimicrobial stewardship continues to be embedded and to improve in both General Practice and Hospitals, although further work is needed in Community Health Trusts
- the Antibiotic Guardian campaign evaluation highlighted that the campaign is effective for increasing knowledge and changing behaviour
Public Health England exists to protect and improve the nation’s health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health. Follow us on Twitter: @PHE_uk and Facebook: www.facebook.com/PublicHealthEngland.
- Data in this release is taken from the annual report of PHE’s English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR), which was published today (18 November 2016) to coincide with European Antibiotic Awareness Day (EAAD).
- The ESPAUR report is available online.
ESPAUR is a programme developed by PHE to improve the surveillance of antibiotic resistance, antibiotic use data and support interventions and toolkits to improve antibiotic prescribing in general practice and hospitals. Each of these areas are key components of the UK cross-government Antimicrobial Resistance (AMR) Strategy
- Prescribing of antibiotics in community settings includes primary care and dental.
- Use of last resort antibiotics has continued to increase in secondary care; these include piperacillin, tazobactam and carbapenems.
Fingertips is a PHE web tool providing data to improve health and wellbeing, and reduce inequalities. The AMR profiles on Fingertips provide data on healthcare associated infections, antibiotic prescribing and resistance among others.
PHE works closely with professional organisations and stakeholders to raise awareness, educate and deliver aspects of the cross-government UK AMR Strategy.
- The NHS England Commissioning for Quality and Innovation (CQUIN) focuses on reducing these antibiotics safely in secondary care from 2016/17 to 2018/2019.
- The Department of Health recently announced plans to reduce infections in the NHS.
- As part of work to increase public and professional engagement around antibiotic resistance, PHE launched the Antibiotic Guardian campaign in 2014. Antibiotic Guardian is a ‘One Health’ campaign which aims to drive changes in behaviour around antibiotic use, by asking individuals to make one pledge about how they can personally help prevent infections, make better use of antibiotics and help protect our vital antibiotics. By November 2016, more than 34,000 people had become Antibiotic Guardians, supporting action to tackle antimicrobial resistance.
- Antibiotic Guardian pledges are available online.
- A new AMR Stewardship Toolkit has been developed for Dental Practices.