What has happened to antimicrobial usage in primary care in the United Kingdom since the SMAC report? - Description of trends in antimicrobial usage using the General Practice Research Database

Background: The aim of the study was to assess antibiotic prescribing within the United Kingdom for three of the Standing Medical Advisory Committee recommendations 'four things which could be done'. Methods: We conducted a retrospective survey of morbidity and antibiotic prescribing data between 1993 and 2001 using the national General Practice Research Database. Antibiotic prescribing was linked to diagnoses of cough/cold and sore throat; length of antibiotic course for uncomplicated cystitis. Results: The rate of antibiotic prescribing for cough/cold declined between 1993 (43.7 per 1000 patient years at risk) and 1999 (23.5 per 1000 patient years at risk) and has since increased slightly (to 30.5 per 1000 patient years at risk in 2001). Antibiotic prescribing for sore throat declined between 1995 (80.6 per 1000 patient years at risk) and 1999 and has since remained static (42.1 per 1000 patient years at risk in 2001). Trimethoprim was the most commonly used antibiotic for episodes of uncomplicated cystitis and the prescription of 3 day (or less) courses has increased from 16.4 per cent in 1998 to 41.5 per cent in 2001. Conclusions: For the SMAC recommendation to limit prescribing for uncomplicated cystitis to 3 days in otherwise fit women there has been demonstrable impact since the publication of the SMAC report. For two recommendations (no prescribing of antibiotics for simple coughs and colds; no prescribing of antibiotics for viral sore throats) the impact has been less clear against the background of a general reduction in antimicrobial prescribing.