Antibiotic Choice in UK General Practice - rates and drivers of potentially inappropriate antibiotic type in UK general practices

Date of Approval: 
2018-04-18 00:00:00
Lay Summary: 
Antibiotic resistance is of global concern. To slow down the development of antibiotic resistance it is important to use antibiotics in the right way, to use the right type of antibiotic, at the right dose, at the right time and for the correct duration. The ultimate goal of this study is to identify which antibiotics are being prescribed for each infectious condition and determine the rate of potentially inappropriate antibiotic choice when prescribing in primary care in the UK; defined as a deviation from two national guidelines. Furthermore, this study will look at the drivers of inappropriate antibiotic choice, identifying factors that increase the risk of receiving the wrong antibiotic at the patient and practice levels. This analysis will also look to see if there is a clustering affect within practices. Overall, this work will highlight specific areas of antibiotic prescribing that may need improving. The work may also identify any difference between practices and their management of infectious conditions over time, identifying practices that may benefit from a targeted intervention for antimicrobial stewardship programmes.
Technical Summary: 
The main objectives of this study are to determine, by conducting a population retrospective cohort study, which antibiotics are prescribed once the decision to prescribe be made for multiple infectious conditions within primary care in the UK. The study also aims to idetify the rate of potentially inappropriate antibiotic prescribing over time; defined as a deviation from two national prescribing guidelines (published 2017): 1) The National Institute for Health and Care Excellence (NICE) 2) Public Health England (PHE) Product codes from The British National Formula will be used to identify antibiotics type at the point of prescribing. Should this prescription deviate from the national guidelines it will be defined as a potentially inappropriate choice of antibiotic. This informaiton will be displayed over time. A multilevel logistic regression will also be used to identify which patient specific and practice specific exposures are key predictors of inappropriate prescribing. To determine any similarities or differences between practice prescribing habits, the proportion of variance that can be attributed to a clustering effect will be analysed by time (year) and practice level. This work will highlight specific areas of antibiotic prescribing that may need improving and better educating a targeted intervention for antimicrobial stewardship programmes in the UK.
Health Outcomes to be Measured: 
If a patient received the recommended antibiotic based on national prescribing guidelines.
Application Number: 

Tjeerd van Staa - Chief Investigator - University of Manchester
Tjeerd van Staa - Corresponding Applicant - University of Manchester
Darren Ashcroft - Collaborator - University of Manchester
Magdalena Nowokowska - Collaborator - Farr Institute of Health Informatics Research
VICTORIA PALIN - Collaborator - University of Manchester