Practices have been highly effective in responding to concerns about over-prescription of antibiotics, according to a new analysis.
An evaluation of national primary care prescribing policy has found a reduction in the numbers of antibiotics being dispensed by primary care settings. Researchers at the University of Bristol examined the relationship between primary care antibiotic dispensing and resistance in community-acquired urinary Escherichia coli infections from Bristol and the surrounding areas between 2013 and 2016.
This period was chosen because the NHS introduced an incentive scheme to reduce antibiotic dispensing from 2014 onwards. The team undertook multilevel modelling analysis of data from 163 primary care practices, which serves 1.5 million patients, and 152,704 urinary E. coli.
Writing in PLOS One, they found reductions in overall and individual antibiotic dispensing in the four-year period. They found that antibiotic dispensing reductions were associated with reduced resistance to ciprofloxacin, trimethoprim and amoxicillin, which happened within three months – and persisted for a further three months for trimethoprim and amoxicillin. However, they found that despite reductions in the dispensing of cefalexin and co-amoxiclav, resistance to these antibiotics increased over time. Despite nitrofurantoin dispensing increasing, the authors found no association with an increase in nitrofurantoin resistance.
Lead study author Dr Ashley Hammond, senior research associate in the Centre for Academic Primary Care, said: “Our study suggests encouraging the first-line use of nitrofurantoin for uncomplicated lower UTI remains a reasonable approach. Whilst it is reassuring that reductions in antibiotic dispensing can result in reductions in resistance over a short timescale, this also suggests national prescribing guidelines will need to be reviewed and updated frequently.”
The team recommended further research to identify what else contributes to the increase in resistance.