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medications 1June 29 2016

There has been an overall reduction of 5.1% in total antibacterial usage in primary care in Wales in 2015 compared to 2014.

However, Public Health Wales has said that more needs to be done to reduce antibacterial prescribing, due to a rise in resistance. It has also raised its concerns about “significant variability” in prescribing practices between health boards.

PHW has published three reports on antibacterial prescribing covering antibacterial resistance, antibacterial prescribing in primary and antibacterial prescribing in secondary care in Wales, for the period 2006-2015.

The report on primary care notes that in 2015, the 5.1% reduction in total antibacterial usage included:

  • an 8.1% reduction in broad-spectrum penicillin usage;
  • a 16.8% reduction in beta-lactam/beta-lactamase inhibitor combinations;
  • a 17.3% reduction in cephalosporins; and
  • a 9.1% reduction in fluoroquinolones.

However, there were increases in two drug antibiotic groups in primary care:

  • tetracyclines (predominantly doxycycline) increased by 5.6% and
  • nitrofurans increased by 4.5%

While the majority of the old Local Health Boards saw a reduction in antibacterial prescribing, “Blaenau Gwent LHB and Rhondda Cynon Taff LHB increased their usage by 4.1% and 1.6% respectively.” In terms of dispensing volume, “Blaenau Gwent LHB had the highest dispensing rate of 626 items/1000 prescribing units per annum and Powys LHB had the lowest dispensing rate with 436 items/ 1000PUs PA. The All-Wales dispensing rate was 545 items/1000 prescribing units per annum.”

Dr Robin Howe, Consultant Microbiologist for Public Health Wales, said: “Antimicrobial resistance is an increasing problem that can result in difficulty in treating infections, leading to failed therapy and potential life threatening complications.

“The antibacterial usage reports found a decrease in antibacterial usage in seven of the 16 acute hospitals in Wales, and 20 of the 22 old Local Health Boards which is a positive outcome but also clearly indicates there is room for improvement. We will be working closely with our partners in an effort to make further improvements.”

Dr Maggie Heginbothom, PHW Clinical Scientist, added that while the overall reduction was pleasing, “we need continued efforts to reduce inappropriate antibacterial prescribing in both primary and secondary care if we are going to make any impact on the rise of antimicrobial resistance.”

In terms of antibiotic classes, the most commonly used type was broad-spectrum penicillins, such as amoxicillin, accounting for 26.5% of total use.

Prescribing levels of other antibiotics were:

  • tetracyclines (eg doxycycline) - 14.1%
  • macrolides (eg clarithromycin) - 11.9%
  • trimethoprim group - 11.7%
  • beta-lactamase-resistant penicillins (eg flucloxacillin) - 11.2%.
  • beta-lactam/beta-lactamase inhibitor combinations (eg co-amoxiclav) - 4.0%
  • cephalosporins - 3.8%
  • fluoroquinolones (e.g. ciprofloxacin) - 2.0%.

PHW’s report on primary care also noted that there was a notable change in the seasonal usage of drug groups, with cephalosporins, fluoroquinolones and beta-lactam/beta-lactamase inhibitor combinations decreasing in the winter. An increase in winter usage of tetracyclines suggested “an increased use for respiratory infections in adherence to guidance.”

Links:

PHW announcement

PHW ‘Antibacterial resistance in Wales 2006-2015’

PHW ‘Antibacterial usage in primary care in Wales 2006-2015’

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