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Prescribing of long-term antibiotics to adolescents in primary care: a retrospective cohort study

Prescribing of long-term antibiotics to adolescents in primary care: a retrospective cohort study
Prescribing of long-term antibiotics to adolescents in primary care: a retrospective cohort study

BACKGROUND: Antibiotic overuse is linked to increased risk of antimicrobial resistance. Long-term antibiotics are commonly used for treating acne and prophylaxis of urinary tract infection. Their contribution to the overall burden of antibiotic use is relatively unknown.

AIM: To describe the volume of commonly prescribed long-term (≥28 days) antibiotic prescriptions in adolescents and young adults, trends over time, and comparisons with acute prescriptions.

DESIGN AND SETTING: A retrospective cohort study using UK electronic primary care records.

METHOD: Patients born between 1979 and 1996 and with data in the Care and Health Information Analytics database were included. The main outcome measures were antibiotic prescription rates per 1000 person-years and antibiotic prescription days per person-year between the ages of 11 and 21.

RESULTS: In total, 320 722 participants received 710 803 antibiotic prescriptions between the ages of 11 and 21 years from 1998 to 2017. Of these 710 803 prescriptions, 191 443 (26.93%) were for long-term antibiotics (≥28 days and ≤6 months in duration). Long-term antibiotics accounted for more than two-thirds (72.48%) of total antibiotic exposure (days per person-year). Total long-term antibiotic prescribing peaked in 2013 at just under 6 days per person-year and declined to around 4 days in 2017.

CONCLUSION: Among adolescents and young adults, exposure to long-term antibiotics (primarily lymecycline used for acne) was much greater than for acute antibiotics and is likely to make an important contribution to antimicrobial resistance. Urgent action is needed to reduce unnecessary exposure to long-term antibiotics in this group. Increasing the use of, and adherence to, effective non-antibiotic treatments for acne is key to achieving this.

Antibiotic prescriptions, Antibiotics, Antimicrobial drug resistance, General practice
0960-1643
e887-e894
Lown, Mark
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McKeown, Sam
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Stuart, Beth
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Francis, Nick
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Santer, Miriam
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Lewith, George
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Su, Fangzhong
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Moore, Michael
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Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Lown, Mark
4742d5f8-bcf3-4e0b-811c-920e7d010c9b
McKeown, Sam
d5159ce4-1a53-4f59-b834-a7760a5760f9
Stuart, Beth
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Francis, Nick
9b610883-605c-4fee-871d-defaa86ccf8e
Santer, Miriam
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Lewith, George
0fc483fa-f17b-47c5-94d9-5c15e65a7625
Su, Fangzhong
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Moore, Michael
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Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777

Lown, Mark, McKeown, Sam, Stuart, Beth, Francis, Nick, Santer, Miriam, Lewith, George, Su, Fangzhong, Moore, Michael and Little, Paul (2021) Prescribing of long-term antibiotics to adolescents in primary care: a retrospective cohort study. The British journal of general practice : the journal of the Royal College of General Practitioners, 71 (713), e887-e894. (doi:10.3399/BJGP.2021.0332).

Record type: Article

Abstract

BACKGROUND: Antibiotic overuse is linked to increased risk of antimicrobial resistance. Long-term antibiotics are commonly used for treating acne and prophylaxis of urinary tract infection. Their contribution to the overall burden of antibiotic use is relatively unknown.

AIM: To describe the volume of commonly prescribed long-term (≥28 days) antibiotic prescriptions in adolescents and young adults, trends over time, and comparisons with acute prescriptions.

DESIGN AND SETTING: A retrospective cohort study using UK electronic primary care records.

METHOD: Patients born between 1979 and 1996 and with data in the Care and Health Information Analytics database were included. The main outcome measures were antibiotic prescription rates per 1000 person-years and antibiotic prescription days per person-year between the ages of 11 and 21.

RESULTS: In total, 320 722 participants received 710 803 antibiotic prescriptions between the ages of 11 and 21 years from 1998 to 2017. Of these 710 803 prescriptions, 191 443 (26.93%) were for long-term antibiotics (≥28 days and ≤6 months in duration). Long-term antibiotics accounted for more than two-thirds (72.48%) of total antibiotic exposure (days per person-year). Total long-term antibiotic prescribing peaked in 2013 at just under 6 days per person-year and declined to around 4 days in 2017.

CONCLUSION: Among adolescents and young adults, exposure to long-term antibiotics (primarily lymecycline used for acne) was much greater than for acute antibiotics and is likely to make an important contribution to antimicrobial resistance. Urgent action is needed to reduce unnecessary exposure to long-term antibiotics in this group. Increasing the use of, and adherence to, effective non-antibiotic treatments for acne is key to achieving this.

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More information

Accepted/In Press date: 27 July 2021
Published date: 25 November 2021
Additional Information: Funding: This project was funded by the National Institute for Health Research School for Primary Care Research: FR 13: Project number 374.
Keywords: Antibiotic prescriptions, Antibiotics, Antimicrobial drug resistance, General practice

Identifiers

Local EPrints ID: 452856
URI: http://eprints.soton.ac.uk/id/eprint/452856
ISSN: 0960-1643
PURE UUID: a4b1dabf-3acd-4eec-8bdf-543872a6dd0e
ORCID for Mark Lown: ORCID iD orcid.org/0000-0001-8309-568X
ORCID for Beth Stuart: ORCID iD orcid.org/0000-0001-5432-7437
ORCID for Nick Francis: ORCID iD orcid.org/0000-0001-8939-7312
ORCID for Miriam Santer: ORCID iD orcid.org/0000-0001-7264-5260
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509

Catalogue record

Date deposited: 21 Dec 2021 17:57
Last modified: 28 Apr 2022 02:28

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Contributors

Author: Mark Lown ORCID iD
Author: Sam McKeown
Author: Beth Stuart ORCID iD
Author: Nick Francis ORCID iD
Author: Miriam Santer ORCID iD
Author: George Lewith
Author: Fangzhong Su
Author: Michael Moore ORCID iD
Author: Paul Little

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