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Antimicrobial stewardship

Antibiotic use in England has fallen for the first time

Report finds primary care in England now uses the lowest amounts of two broad spectrum antibiotic classes — cephalosporins and quinolones — compared to elsewhere in the EU.

For the first time, fewer antibiotics are being prescribed for use in both primary and secondary care in England, according to the annual report of the antibiotic surveillance programme run by Public Health England (PHE).

The English Surveillance Programme for Antimicrobial Utilisation and Resistance report, which was published on 18 November 2016, revealed that total antibiotic consumption in general practice, hospitals and dental practices — measured as a ‘defined daily dose’ (DDD) — declined by 4.3% between 2014 and 2015 from 22.9 to 21.8 DDD per 1,000 inhabitants per day.

Antibiotic prescribing in primary care — measured as the number of prescriptions dispensed per specific therapeutic group age-sex related prescribing units (STAR-PU) — was at the lowest level in 2015 since 2011 (1.110 items per STAR-PU in 2015 compared to 1.233 items per STAR-PU in 2011).

The use of broad spectrum antibiotics also dropped in primary care for the second year running, according to the report.

The report also says that primary care in England now uses the lowest amounts of two broad spectrum antibiotic classes — cephalosporins and quinolones — compared to elsewhere in the EU. However, this trend is not reflected in hospitals in England where the use of ‘last resort’ antibiotics, such as piperacillin/tazobactam, carbapenems and colistin, continues to increase.

The ongoing increase in the use of piperacillin/tazobactam — which has risen by 50% in the last five years — is associated with a “significant” increase in resistance bloodstream infections of Escherichia coli and Klebsiella pneumoniae, the report says.

The report also notes that, between 2010 and 2014, the rate of bloodstream infections caused by E. coli increased by 15.6%, and K. pneumoniae increased by 20.8%. This trend continued between 2014 and 2015 when E. coli bloodstream infections increased by 4.6% and K. pneumoniae went up by 9%.

“Tackling these infections is a key government priority,” the report says.

Susan Hopkins, the report’s lead author and an epidemiologist at PHE, says: “The overall decrease in the number of antibiotics being prescribed is great news but we can’t become complacent.”

Mike Duran, national director of patient safety for the NHS, says the decline in antibiotic prescribing is down to the “huge efforts of healthcare staff”.

He adds that there are plans to bring in new national incentive schemes in 2017 to help reduce the antibiotic prescribing figures further and help achieve the government’s target to see specific inappropriate antibiotic prescribing down by 50% in the next five years.

The British Society for Antimicrobial Chemotherapy, a membership organisation that specialises in issues relating to antimicrobial agents, welcomed the report’s findings.

Its president, Dilip Nathwani, says: “This is encouraging evidence that antimicrobial stewardship initiatives are leading to changes in antibiotic prescribing practices and public expectations.

“The immediate challenge is to sustain and spread these changes through multidisciplinary approaches, including professional and public education programmes. Only through sustained action will we be able to contain or reduce antibiotic resistance.”

 

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2016.20201981

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