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There has been a “massive change” in the prescribing of antibiotics for children in primary care since the COVID-19 pandemic, according to Kieran Hand, antimicrobial resistance national clinical lead for pharmacy and prescribing at NHS England.
Speaking at the Clinical Pharmacy Congress, held in London on 9 and 10 May 2025, Hand told delegates: “[Before the COVID-19 pandemic] … 27% of all children in England aged under 10 [years] received an antibiotic in any given year; after the pandemic it’s risen to 36%.”
Hand added that this increase in prescribing for children is against a backdrop of an overall reduction of 3.2% in antibiotic prescriptions issued to patients of all ages in general practice between 2022/2023 and 2023/2024.
“That’s a massive change in clinical practice and we’re still trying to understand what’s driven that, what are the reasons for it,” Hand said.
“Is it about more risk averse behaviour, is it about the incidence of circulating viral infections?”
Hand went on to say that this increase in antibiotic prescribing matters because “increasingly research is showing that if you expose young children to antibiotics, you cause harm that we don’t even fully understand, you disrupt their microbiome, their normal flora, this has consequences that might be relevant for inflammatory diseases”.
He added that research is now starting to show that children exposed to antibiotics at a young age are more likely to develop asthma, food allergies, hayfever symptoms and even intellectual disability.
“So there are real consequences here for children and I think we need to get back to that pre-pandemic prescribing level, we owe it to our children to do that,” he said.
Hand listed some of the actions that NHS England is taking to tackle antibiotic prescribing in children.
“A big change this year for primary care from NHS England is there’s a new dashboard of performance metrics called the performance and assessment framework, and we have secured a metric in that for antibiotic exposure in children [aged] under ten [years old], and the target in that is to try to get back to pre-pandemic levels of exposure,” he said.
The NHS PrescQIPP dashboard, which was launched in April 2025, uses routine antibiotic prescribing data to report integrated care board (ICB) performance against this metric.
Hand said: “The variation is almost two-fold, certainly across sub-ICBs — there’s no real rational for that variation except just different clinical practice, so plenty of opportunity for improvement there.”
In May 2024, the government published the UK antimicrobial resistance five-year national action plan — ‘Confronting antimicrobial resistance 2024 to 2029’ — which includes strengthening antimicrobial stewardship with a target of reducing total antibiotic use in the UK population by 5% from the 2019 baseline.
