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 Dec;69(12):3423-30. doi: 10.1093/jac/dku291. Epub 2014 Aug 4.


Objectives: To measure trends in antibiotic prescribing in UK primary care in relation to nationally recommended best practice.

Patients and methods: A descriptive study linking individual patient data on diagnosis and prescription in a large primary care database, covering 537 UK general practices during 1995-2011.

Results: The proportion of cough/cold episodes for which antibiotics were prescribed decreased from 47% in 1995 to 36% in 1999, before increasing to 51% in 2011. There was marked variation by primary care practice in 2011 [10th-90th percentile range (TNPR) 32%-65%]. Antibiotic prescribing for sore throats fell from 77% in 1995 to 62% in 1999 and then stayed broadly stable (TNPR 45%-78%). Where antibiotics were prescribed for sore throat, recommended antibiotics were used in 69% of cases in 2011 (64% in 1995). The use of recommended short-course trimethoprim for urinary tract infection (UTI) in women aged 16-74 years increased from 8% in 1995 to 50% in 2011; however, a quarter of practices prescribed short courses in ≤16% of episodes in 2011. For otitis media, 85% of prescriptions were for recommended antibiotics in 2011, increasing from 77% in 1995. All these changes in annual prescribing were highly statistically significant (P < 0.001).

Conclusions: The implementation of national guidelines in UK primary care has had mixed success, with prescribing for coughs/colds, both in total and as a proportion of consultations, now being greater than before recommendations were made to reduce it. Extensive variation by practice suggests that there is significant scope to improve prescribing, particularly for coughs/colds and for UTIs.

Keywords: antibiotic prescribing; otitis media; primary care; respiratory tract infections; surveillance trends; urinary tract infections.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Drug Prescriptions / standards*
  • Drug Therapy / standards
  • Drug Utilization / standards*
  • Female
  • Guideline Adherence
  • Health Policy
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Primary Health Care / methods*
  • United Kingdom
  • Young Adult


  • Anti-Bacterial Agents