Health e-Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
NHS Greater Manchester Shared Service, Oldham, UK.
Br J Gen Pract. 2019 Jan;69(678):e42-e51. doi: 10.3399/bjgp18X700457. Epub 2018 Dec 17.
High levels of antibiotic prescribing are a major concern as they drive antimicrobial resistance. It is currently unknown whether practices that prescribe higher levels of antibiotics also prescribe more medicines in general.
To evaluate the relationship between antibiotic and general prescribing levels in primary care.
Cross-sectional study in 2014-2015 of 6517 general practices in England using NHS digital practice prescribing data (NHS-DPPD) for the main study, and of 587 general practices in the UK using the Clinical Practice Research Datalink for a replication study.
Linear regression to assess determinants of antibiotic prescribing.
NHS-DPPD practices prescribed an average of 576.1 antibiotics per 1000 patients per year (329.9 at the 5th percentile and 808.7 at the 95th percentile). The levels of prescribing of antibiotics and other medicines were strongly correlated. Practices with high levels of prescribing of other medicines (a rate of 27 159.8 at the 95th percentile) prescribed 80% more antibiotics than low-prescribing practices (rate of 8815.9 at the 5th percentile). After adjustment, NHS-DPPD practices with high prescribing of other medicines gave 60% more antibiotic prescriptions than low-prescribing practices (corresponding to higher prescribing of 276.3 antibiotics per 1000 patients per year). Prescribing of non-opioid painkillers and benzodiazepines were also strong indicators of the level of antibiotic prescribing. General prescribing levels were a much stronger driver for antibiotic prescribing than other risk factors, such as deprivation.
The propensity of GPs to prescribe medications generally is an important driver for antibiotic prescribing. Interventions that aim to optimise antibiotic prescribing will need to target general prescribing behaviours, in addition to specifically targeting antibiotics.
高剂量的抗生素处方是一个主要关注点，因为这会导致抗生素耐药性。目前尚不清楚开处方抗生素水平较高的做法是否也会普遍开更多的药物。
评估初级保健中抗生素和一般药物处方水平之间的关系。
2014-2015 年，在英格兰的 6517 家普通诊所中进行了一项横断面研究，使用 NHS 数字处方数据（NHS-DPPD）进行主要研究，在英国的 587 家普通诊所中使用临床实践研究数据链接（CPRD）进行复制研究。
线性回归评估抗生素处方的决定因素。
NHS-DPPD 实践中，每 1000 名患者平均开具 576.1 种抗生素/年（第 5 百分位数为 329.9，第 95 百分位数为 808.7）。抗生素和其他药物的处方水平高度相关。高剂量开具其他药物的处方（第 95 百分位数为 27159.8）的实践开具的抗生素比低剂量开具的处方多 80%（第 5 百分位数为 8815.9）。调整后，高剂量开具其他药物的 NHS-DPPD 实践开具的抗生素处方比低剂量开具的处方多 60%（相当于每 1000 名患者每年多开 276.3 种抗生素）。非阿片类止痛药和苯二氮䓬类药物的处方也是抗生素处方水平的重要指标。与贫困等其他风险因素相比，一般处方水平是抗生素处方的一个更重要的驱动因素。旨在优化抗生素处方的干预措施将需要针对一般处方行为，除了专门针对抗生素。
