England has already achieved the UK government’s goal to reduce antibiotic prescribing by 15% by 2024, according to the 2021/2022 ‘English surveillance programme for antimicrobial utilisation and resistance’ (ESPAUR) report.
However, the UK Health Security Agency (UKHSA) has warned that the downward trend “may not be sustained” unless antibiotics are continually used appropriately to drive down infections.
The ESPAUR report, published annually, brings together relevant information to inform on trends and the impact of external forces on antimicrobial prescribing, as well as progress towards the five-year antimicrobial resistance (AMR) national action plan.
The action plan, published on 21 November 2022, included ambitions to reduce the total number of antibiotic-resistant infections in the UK by 10% from the 2018 baseline by 2025, and to reduce antibiotic prescribing by 15% by 2024 from a 2014 baseline.
The ESPAUR report showed that total antibiotic consumption in England declined by 15.1% between 2017 to 2021, from 18.8 daily defined doses (DDD) per 1,000 inhabitants per day to 15.9 DDD.
It also showed that there has been a 9.1% reduction in antibiotic-resistant infections in England between 2018 and 2021.
The report highlighted that 50% of integrated care systems had met the national action plan target for reducing total antimicrobial prescribing in primary care by the end of the 2021/2022 financial year, and 50% of participating acute trusts had met the reinstated NHS standard contract target to reduce total consumption of antimicrobials by 2% (from 2018 baseline).
The report said it was “unclear” how much the COVID-19 pandemic and subsequent changes in the healthcare system had contributed towards these achievements.
It also showed that the estimated total number of serious antibiotic-resistant infections in England rose by 2.2% in 2021 compared with 2020, the equivalent of an estimated 148 severe antibiotic resistant infections per day in 2021.
Antibiotic prescribing continued to be highest in general practice (72.1%), with a marginal reduction seen in this setting, from 11.65 to 11.49 DDDs per 1,000 inhabitants per day between 2020 and 2021. Hospital inpatient, hospital outpatient and other community settings saw an increase in consumption between 2020 and 2021.
Susan Hopkins, chief medical adviser at the UKHSA, said: “We are already seeing resistance emerge to our very newest antibiotics.
“Innovation to find new treatments will only succeed if we use what we have responsibly. Overuse of antibiotics will mean they stop working against life-threatening conditions, such as sepsis.”
Dame Jenny Harries, chief executive of the UKHSA, added that AMR was “not a distant problem that we can ignore”.
“As we emerge from the COVID-19 pandemic, this is a pivotal moment to maintain focus on the ‘silent pandemic’ of antibiotic resistance through our extensive surveillance and antibiotic stewardship activities.”
Neil Powell, consultant antimicrobial pharmacist at Royal Cornwall Hospitals NHS Trust, said it was “really encouraging” to see that antibiotic use has decreased in line with national action plan ambitions.
“We know that more can be done to safely reduce antibiotic use through antibiotic course length optimisation,” he said.
“Both primary and secondary care are working to further embed short antibiotic course lengths, which will see a further reduction in antibiotic use across both primary and secondary care.”