Antibiotic prescribing

We look at prescribing patterns for antibiotics, both in England and internationally.

Indicator

Last updated: 18/07/2019

Effective clinical care
Primary and community care

Background

Antimicrobial resistance (AMR) is one of the biggest threats to global public health. Without effective antibiotics, the prevention and treatment of infections would be compromised. The UK’s 20-year vision for antimicrobial resistance sets out how the UK will contribute to containing and controlling AMR by 2040. One of the key strategies is to optimise the use of antimicrobials in humans by improving prescribing behaviours. Studies have shown that at least 20% of antibiotics prescribed in primary care in England are inappropriate. These indicators look at how antibiotic prescribing has changed over time, both in England and internationally.


How does the volume of antibiotics prescribed in primary care compare internationally? 18/07/2019

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The OECD collects data on antibiotic prescribing in primary care in different countries, using a system of Defined Daily Doses (DDDs) to measure the volume of drugs. Between 2000 and 2014, the volume of antibiotics prescribed in the UK increased from 14.3 DDDs per 1,000 inhabitants per day to 19.7 DDDs per 1,000 inhabitants per day. Since then, the volume has decreased to 18 DDDs per 1,000 inhabitants per day in 2018. The volume of antibiotics prescribed in primary care in the UK is about average for the comparator countries. While the recent decrease in volume prescribed is promising, the UK’s prescribing levels are approximately double that of the Netherlands. Antibiotic prescribing is high in France, Ireland and Italy, and low in the Netherlands, Austria and Sweden.


How has antibiotic consumption in England changed over time by provider setting? 18/07/2019

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In England, the total consumption of antibiotics in primary and secondary care declined by 4.5%, from 22.1 Defined Daily Doses (DDDs) per 1,000 inhabitants per day in 2013 to 21.1 DDDs per 1,000 inhabitants per day in 2017. This overall decrease will contribute towards the UK’s five-year national action plan that set a target to reduce the UK’s antimicrobial use in humans by 15% by 2024.

While most antibiotic prescribing occurs in general practice (72.4% of total prescribing in 2017), consumption in this setting has declined over time (-9.2%). This contrasts with prescribing in other community settings, which has continued to increase despite accounting for a relatively small proportion of overall antimicrobial prescribing (3.5% of total prescribing in 2017).

Antibiotic consumption has also increased within secondary care, for both inpatients (+4.8%) and outpatients (+20.8%). This is partly due to antibiotic shortages and the practice of replacing a single broad-spectrum antibiotic with two or three narrower antibiotics that have the same clinical impact.


About this data

Definitions and comparability for the OECD indicator are taken directly from the OECD report Health at a Glance 2017: OECD indicators. Detailed information about the definitions, source and methods for each country can be found here.

Defined daily dose (DDD) is the assumed average maintenance dose per day for a drug used for its main indication in adults. DDDs are assigned to each active ingredient in a given therapeutic class by international expert consensus. DDDs do not necessarily reflect the average daily dose actually used in a given country.

Data for Spain, the United Kingdom, Portugal and Sweden include data for primary care physicians only. Data for Canada, Ireland and New Zealand include only those dispensed by community pharmacies. Data for Finland and Italy include outpatients only. Data for Australia include prescriptions dispensed at community pharmacies, private hospital pharmacies and to public hospital outpatients and admitted day patients. Results for Canada only include data from the provinces of British Columbia, Manitoba and Saskatchewan.

Denominators comprise the population held in the national prescribing database, rather than the general population.

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