Breaking records: Using health records to explore antibiotic
prescribing practice

The Problem

Antibiotics are the bedrock of modern medicine.  Without antibiotics a routine operation could be life-threatening; immunosuppressive cancer therapies and organ transplantation would be impossible.  Yet bacteria keep developing resistance because of evolution.  Until recently we have been shielded from the terrible consequences of antimicrobial resistance because there has been a steady supply of new antibiotics.  This is no longer the case, and unless we take action now antimicrobial resistance will cause an estimated 10 million extra deaths per year by 2050.

Antimicrobial resistance is driven by the overuse of antibiotics, in humans and animals. Three-quarters of antibiotics are prescribed in General Practice, but the majority of drug resistant infections are seen in hospital, where vulnerable patients encounter drug-resistant pathogens and broad spectrum antibiotics are often prescribed empirically. Our research focuses on understanding how and why antibiotics are prescribed from the perspective of the prescriber and the patient.

Our research

Electronic health records provide a valuable repository of information on antibiotic prescriptions. A recent analysis carried out by Professor Andrew Hayward and colleagues identified both an increase in antibiotic prescribing in general practice, following many years of decline, and wide variation between practices.

Back in 2007, Professor Hayward and colleagues used the General Practice Research Database (now the Clinical Practice Research Datalink) to explore patterns of antibiotic usage. This analysis identified the conditions for which antibiotics were most commonly prescribed and which antibiotics patients received. For several conditions, antibiotic usage was inappropriately high, although the antibiotics prescribed were generally those recommended in guidelines.

A more recent analysis published in 2014, covering data from more than 500 general practices, found significant increases in use of antibiotics. For example, although the proportion of cough/cold consultations for which antibiotics were prescribed fell between 1995 and 1999 (from 47% to 36%), it rose again to 51% in 2011. Prescriptions for sore throats declined from 77% in 1995 to 62% in 1999 but showed no further falls thereafter.

The analysis also revealed wide variation in antibiotic prescribing behaviour between practices suggesting there is an opportunity to improve prescribing behaviour in general practice.

To safely reduce the use antibiotics in primary care we need to understand patient and the public’s views on antimicrobial resistance. Recent work carried out by Dr Laura Shallcross and colleagues at University College London Hospital demonstrates that more work needs to be done to communicate public health messages about antibiotic use to the general public. More than a quarter of those surveyed thought that antibiotics were an effective treatment for viruses.

Dr Shallcross has also recently worked with the Chief Medical Officer publishing a number of articles and reports that highlight the problems of antimicrobial resistance and the steps that need to be taken to combat it.

Themes

Publications

Hayward AC et al. Report of the Specialist Advisory Committee on Antimicrobial Resistance (SACAR) Surveillance Subgroup. J Antimicrob Chemother. 2007;60 Suppl 1:i33–42.

Hawker JI et al. Trends in antibiotic prescribing in primary care for clinical syndromes subject to national recommendations to reduce antibiotic resistance, UK 1995-2011: analysis of a large database of primary care consultations. J Antimicrob Chemother. 2014;69(12):3423–30.

Shallcross LJ et al. Are the public getting the message about antimicrobial resistance? Archiv Public Health. 2015; 73:55

Shallcross LJ, Davies SC. Antibiotic overuse: a key driver of antimicrobial resistance. Br J Gen Pract 2014 Dec; 64(629): 604–605. 

Shallcross LJ, Davies SC. The World Health Assembly resolution on antimicrobial resistance. J Antimicrob Chemother 2014;  69 (11): 2883-2885. 

Shallcross LJ et al. Tackling the threat of antimicrobial resistance: from policy to sustainable action. Philos Trans R Soc Lond B Biol Sci 2015; 370: 20140082.  

Impact in research