A study evaluating, for the first time, national primary care prescribing policy on community antibiotic resistant infection in England has found reductions in overall and individual antibiotic dispensing between 2013 and 2016.
The study, published in PLoS ONE, investigated the relationship between primary care antibiotic dispensing and resistance in community-acquired urinary Escherichia coli (E.coli) infections in south west England. The period 2013 and 2016 was chosen because the NHS introduced an incentive scheme to reduce antibiotic dispensing from 2014 onwards.
Researchers carried out multilevel logistic regression modelling investigating relationships between primary care practice level antibiotic dispensing for approximately 1.5 million patients (163 primary care practices) and resistance in 152,704 community-acquired cases of urinary E. coli.
In line with national trends, overall antibiotic dispensing per 1000 registered patients fell 11%. Amoxicillin fell 14%, cefalexin 20%, ciprofloxacin 24%, co-amoxiclav 49%, and trimethoprim 8%. Nitrofurantoin increased 7% during the period.
Antibiotic reductions were associated with reduced within quarter resistance to: amoxicillin, ciprofloxacin and trimethoprim. Subsequent quarter reduced resistance was observed for trimethoprim and amoxicillin.
Antibiotic dispensing reductions were associated with increased within and subsequent quarter resistance to cefalexin and co-amoxiclav; however this could result from residual confounding, the authors said, adding that randomised controlled trials are urgently required to investigate causality.
Increased nitrofurantoin dispensing was associated with reduced within and subsequent quarter trimethoprim resistance without affecting nitrofurantoin resistance.
Dr Ashley Hammond, Senior Research Associate in the University of Bristol Centre for Academic Primary Care and lead author, said: "Our study suggests encouraging the first-line use of nitrofurantoin for uncomplicated lower UTI [urinary tract infection] 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."
