ata from the first annual report of Public Health England’s (PHE’s) English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR), 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.coliwith varying levels of resistance to key antibiotics for this infection of between 10 to 19%.
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.
Key findings of the report include:
• 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 period GP prescribing rose by 4%, prescribing to hospital inpatients rose by 12% and other community prescriptions rose by 32%. This latter area is of concern and needs to be further examined.
• The increasing number of E. colibloodstream 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.
Commenting on the report findings, Dr Susan Hopkins, a healthcare epidemiologist at PHE and lead author of the report, 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.”
