A new report from Public Health England (PHE) found that between 2010 and 2013 there was a 6% increase in the combined antibiotic prescribing of GPs and hospitals. There was also an increase of 12% in the number of bloodstream infections caused by E.coli with varying levels of resistance to key antibiotics for this infection of between 10 to 19%.
These data are from the first annual report of PHE’s English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR), published today (10 October 2014).
While the proportion of resistant infections remains the same as that seen in previous years, as the total number of infections has increased so the total number of resistant infections has risen. The report also shows a wide variation in both prescribing habits and antibiotic usage across England.
- between 2010 and 2013 total antibiotic consumption (GPs and hospitals) rose by 6% from 25.9 to 27.4 daily defined dose* per 1,000 inhabitants per day
- over the same 4-year period GP prescribing rose by 4%, prescribing to hospital inpatients rose by 12% and other community prescriptions (dentists and other non-GP prescribing) rose by 32%. This latter area is of concern and needs to be further examined
- the increasing number of E.coli bloodstream infections has seen a corresponding increase in levels of resistance to a number of key antibiotics
- higher rates of resistance were seen in those areas with higher rates of prescribing
- there was a difference in prescribing between the north and south of the country. This is an area that needs more investigation but some of the differences may be due to deprivation, higher rates of smoking, co-morbidities, and other factors
- the highest levels of GP prescribing were seen in Durham, Darlington and Tees which was over 40% higher than London (26.5 versus 18.9 daily defined dose per 1,000 inhabitants). However, this may be due to access to healthcare in London (with people attending hospitals instead of GP practices to access treatment), as London has the highest amount of hospital prescribing per population
Lead author Dr Susan Hopkins,
healthcare epidemiologist at PHE, said:
” This publication marks a real move forward in our understanding of antibiotic prescribing habits as it is the first time that both GP and hospital prescribing data have been collated in one document and prescribing trends analysed.
The aim now must be to reduce levels of prescribing back to that seen in 2010. There are already a number of different activities going ahead to support this including the development of quality measures for prescribing. This will enable local clinical commissioning groups to monitor the prescribing of hospitals and surgeries in their area and see how they compare against a benchmark. They will also be responsible for taking action against inappropriate prescribing in their area.
In addressing the issue of antibiotic resistance it is important to look at the whole healthcare economy approach. There is a lot of work going on to address the problem of antibiotic resistance but we must not underestimate how much work needs to be done to turn the tide and get levels of resistance down. ”
Professor John Watson,
deputy chief medical officer at the Department of Health, said:
” Antimicrobial resistance is one of the biggest threats to health security facing the world today and everybody must take action. We want to support all doctors and other prescribers in reducing their prescribing rates where possible. These data will play an important part in highlighting regional variations in prescribing. ”
Professor Anthony Kessel,
director of international public health at PHE, said:
” We cannot underestimate the importance of this report. Antibiotic resistance is one of the biggest threats of our time and understanding more about who is prescribing and what is being prescribed is the first step to helping us make improvements.
In England we are progressing and implementing a raft of tools to help us reduce the levels of prescribing and resistance and these include benchmarking, accountability on prescribing and quality measures. We are also asking everyone in the UK, the public and the medical community, to join our campaign and become an Antibiotic Guardian. We want everyone to choose one simple pledge about how they make better use of antibiotics and help save these vital medicines from becoming obsolete.
ESPAUR was established as a response to the UK cross government 5-year strategy to address the growing problem of antibiotic resistance. The report focuses on the use of antibiotics, stewardship and levels of resistance by NHS area team across GP practices and hospitals (primary and secondary care). ”
Public Health England Reports:
- New report reveals increase in use of antibiotics linked to rising levels of antibiotic resistance, press release, 10 October 2014.
- English surveillance programme antimicrobial utilisation and resistance report 2014.
- UK 5 Year Antimicrobial Resistance Strategy 2013 to 2018, PDF 2013.
- Infections and the rise of antimicrobial resistance report 2013.
2014 UK Newspapers Headlines:
- Antibiotic resistance continues to rise, NHS Choices, October 10 2014.
- Antibiotic resistance rise continues. BBC News, October 10 2014.
- Doctors urged to cut antibiotics prescriptions. The Guardian, October 10 2014.
- Out-of-hours GPs ‘are fuelling a huge rise in drug-resistant bacteria’: Number of antibiotics handed out at evenings and weekends up by a third since 2010. Daily Mail, October 10 2014.
- Hospitals and out of hours GPs are driving rise in antibiotics: report. The Daily Telegraph, October 10 2014.
- Doctors urged to become ‘cleverer’ in use of antibiotics. ITV News, October 10 2014.
- Health watchdog issues alert over needless antibiotic prescriptions. Daily Express, October 10 2014.
2013 UK Newspapers Headlines:
- Superbug threat is ‘ticking time bomb’, NHS Choices, March 11 2013.
- Antibiotics resistance ‘as big a risk as terrorism’ – medical chief. BBC News, March 11 2013.
- New wave of ‘superbugs’ poses dire threat, says chief medical officer. The Guardian, March 11 2013.
- Resistance to antibiotics risks health ‘catastrophe’ to rank with terrorism and climate change. The Independent, March 11 2013.
- Threat posed by resistance to antibiotics ‘ranks alongside terrorism’. The Daily Telegraph, March 11 2013.
- Superbugs ‘will send the health service back to 19th century’: Even routine surgery could become deadly, warns top medical adviser. Daily Mail, March 11 2013.
- Warning issued over superbug threat. Channel 4 News, March 11 2013.
- Antibiotics resistance as big a risk to Britain as terrorism, claims medical chief. Metro, March 11 2013.
- Antibiotic Resistance ‘A Ticking Time Bomb’. Sky News, March 11 2013.