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Antimicrobial resistant infections keep rising despite fall in GP prescriptions

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4502 (Published 18 November 2020) Cite this as: BMJ 2020;371:m4502
  1. Elisabeth Mahase
  1. The BMJ

Antimicrobial resistant infections in England increased from 61 946 in 2018 to 65 162 in 2019—equivalent to 178 infections a day—despite antibiotic consumption continuing to fall.

The total consumption of antibiotics last year fell to 17.9 defined daily doses per 1000 people per day in 2019, compared with 19.4 in 2015, according to the English Surveillance Programme for Antimicrobial Utilisation and Resistance.1

This was mainly because of a sustained reduction (12.2% between 2015 and 2019) in antibiotics prescribed by general practice (which accounts for 71.4% of total consumption). A reduction of nearly one fifth (19.5%) has also been seen in NHS dental practices. A rise in consumption over the past five years has, however, been seen in other community settings (28.7%) and in secondary care (8.8%, this setting accounts for 21.0% of total consumption).

Antimicrobial resistant bloodstream infections have increased by a third (32%) since 2015 from 13 671 to over 18 000. Escherichia coli has remained the most common bloodstream infection, rising 14% from 68.3 cases per 100 000 population in 2015 to 77.5 in 2019.

The report found that in 2019-20, half of clinical commissioning groups (CCGs) met or exceeded the national target to reduce antibacterial items to at or below 0.965. Meanwhile, 90% of CCGs met or exceeded the national targets to reduce the proportion of co-amoxiclav, cephalosporins, and quinolones to ≤10%. However, only 43 (30%) acute NHS trusts met or exceeded the NHS standard contract requirement to deliver a 1% or greater reduction in total antibiotic consumption from their 2018 calendar year baseline value.

Isabel Oliver, Public Health England National Infection Service director, said, “We want the public to join us in tackling antimicrobial resistance—listen to your GP, pharmacist, or nurse’s advice and only take antibiotics when necessary.

“It’s worrying that more infections are becoming resistant to these life saving medicines. Taking antibiotics when you don’t need them can have grave consequences for you and your family’s health, now and in the future.”

Last year, the World Health Organization urged governments to implement the AWaRe tool, which classifies antibiotics into three groups—access, watch, and reserve—to enable clinicians to know which antibiotics to use for common or serious infections, which ones should be used sparingly or preserved, and which should be used only as a last resort.2

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