Antibiotic prescribing

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.

Antibiotic consumption by provider 

In England, the total consumption of antibiotics in primary and secondary care declined by 5.3%, from 18 Defined Daily Doses (DDDs) per 1,000 inhabitants per day in 2018, to 17 DDDs per 1,000 inhabitants per day in 2022 (data not shown). This overall decrease will contribute towards the UK’s five-year national action plan, which aims to accomplish a reduction in antimicrobial use in humans by 15% by 2024.

For all settings, consumption decreased in 2020 due to a range of factors including fewer face-to-face consultations in primary care, fewer hospital admissions, increased infection prevention measures and a different case-mix of older, more acutely ill patients.

While most antibiotic prescribing occurs in general practice (72% of total prescribing in 2023), consumption in this setting has declined over time (a 17% decrease since 2014). This contrasts with prescribing in ‘other community’ settings, which has flatlined, accounting for a relatively small proportion of overall antimicrobial prescribing (4% of total prescribing in 2023).

Antibiotic consumption within secondary care has remained the same for inpatients but has decreased by 12% for hospital outpatients between 2014 and 2023. This is partly due to antibiotic shortages and replacements of a single broad-spectrum antibiotic with two or three narrower antibiotics that have the same clinical impact. 

Antibiotic prescriptions by country

The European Centre for Disease Prevention and Control collects data on antibiotic prescribing in different countries, using a system of Defined Daily Doses (DDDs) to measure the volume of drugs. Between 2013 and 2019, the volume of antibiotics prescribed in the UK fell from 20 DDDs per 1,000 inhabitants per day to 18 DDDs per 1,000 inhabitants per day.

The volume of antibiotics prescribed in primary care in the UK was lower than average among the comparator countries in 2022. While the recent decrease in volume prescribed is promising, as of 2022, the UK’s prescribing levels were almost double that of the Netherlands. Antibiotic prescribing is high in Greece, France, Spain and Ireland and is low in the Netherlands, Sweden, Canada and Finland. Data for the most recent year is not available for all countries.

Second-line antibiotic prescriptions by country

Quinolones and cephalosporins are considered second-line antibiotics in most prescribing guidelines. Their use should be restricted to situations where first-line antibiotics have failed. It is important that they are used sparingly to avoid drug-resistant bacteria developing. The European Centre for Disease Prevention and Control (ECDC) collects international data on the use of quinolones and cephalosporins.

In the UK, the percentage of antibiotics prescribed that were quinolones or cephalosporins decreased from 9% in 2000 to 4% in 2019 and has since remained roughly stable. In 2019, the UK performed the best out of the comparator countries, while Italy performed the worst. Data for the UK has not been published since 2019, nor for Sweden since 2021. In 2023, Denmark performs the best put the comparator countries (4%), while Greece performs the worst (35%).