Antibiotic prescribing rates in England are falling

Editor—The figure in Dobson's short article in the news roundup shows that Greek doctors prescribe the most antibiotics.¹ In contrast, general practitioners in England have responded to concerns about the overuse of antibiotics by reducing their antibiotic prescribing rates.² The number of antibiotic prescriptions dispensed in the community decreased by 25% between 1995 and 2000, from 49.4 to 36.9 million prescriptions (figure). A more detailed analysis of prescribing data from 210 practices in 1994-8 showed that the largest reductions in antibiotic prescribing rates were seen among children.² Large falls in these rates among children have also occurred elsewhere—for example, in the United States.³

The change in prescribing practice in England predates the Department of Health's initiative (launched in 1998) to reduce community antibiotic prescribing rates (www.claphamhealth.org.uk/Clinical/Antibiotic.html). This suggests that general practitioners were already aware of the need to reduce antibiotic prescribing and of the limited effectiveness of antibiotics for many common community infections and had begun to change their prescribing practice to reflect this. The large decline seen among children may be because many of the guidelines on antibiotic prescribing are for upper respiratory tract infections and otitis media, both of which are common in children.⁴,⁵

We know less about trends in antibiotic prescribing in hospitals because these data are not collected centrally. This is paradoxical because the problem of antibiotic resistance is greatest in hospitals. This deficiency needs to be addressed if we are to monitor the impact of initiatives to reduce antibiotic prescribing in hospitals in the same way that is already possible for antibiotic prescribing in the community.

Figure.

Decrease in antibiotic prescribing by general practitioners in England, 1991-2000