General prescribing levels drive antibiotic prescribing in primary care, study finds

Interventions to optimise antibiotic prescribing need to target general prescribing behaviour more widely, a study published in the
British Journal of General Practice
(18 December 2018) has concluded.

Researchers carried out a cross-sectional study of 6,517 general practices in England using NHS digital practice prescribing data (NHS-DPPD) for the main study, and of 587 general practices in the UK using the Clinical Practice Research Datalink, for a replication study.

The NHS-DPPD practices prescribed an average of 576.1 antibiotics per 1,000 patients per year. The researchers found that prescribing of antibiotics at practice level was strongly correlated with prescribing of other medicines, non-opioid analgesics, and benzodiazepines. Futhermore, explorative analyses found that prescribing of proton pump inhibitors was also associated with antibiotic prescribing.

After statistical adjustment they found that practices which were high prescribers of other medicines gave 60% more antibiotics prescriptions than low-prescribing practices.

Overall it was found that general prescribing levels were a much stronger driver of antibiotic prescribing than other risk factors, such as deprivation.

The researchers concluded that new approaches to modifying prescribing patterns could therefore include measures such as integrating pharmacists within practices, regular reviews of overall prescribing behaviour and comparison with similar practices.

“The propensity of GPs to prescribe medications generally is an important driver for antibiotic prescribing. Interventions that aim to optimise antibiotic prescribing will need to consider general prescribing behaviours of GPs,” they said.