Report finds reducing primary care antibiotic use 'not enough' to halt antimicrobial resistance

A new report led by researchers at Imperial College London has found that reducing antibiotic prescribing in primary care may not be enough alone to halt the rise in drug resistant Escherichia coli (E. Coli) infections in England.

The report is the first evaluation of NHS England’s 'Quality Premium' scheme, which rewarded groups of GPs for quality of care improvements, including the reduction of inappropriate antibiotic prescribing.

The Global Digital Health unit team at Imperial linked data from 6,882 English general practices with Public Health England’s (PHE) national surveillance of bacterial infections over the six-year period from January 2013 to December 2018 when the NHS Quality Premium was in operation.

The report found that although the intervention saw a downward step change in antibiotic prescribing, this only led to a modest reduction in antibiotic resistant infections from E. coli.

Dr Céire Costelloe, reader and director of the Global Digital Health Unit at Imperial College London said: “We found that although the NHS England Quality Premium on antimicrobial resistance (AMR) succeeded in reducing broad spectrum antibiotic prescribing, resistance among E coli causing bacteraemia remains on an upward trajectory, despite an initial attenuation. A multifactor, multisectoral, collaborative and global approach is needed, taking into consideration antibiotic use across the entire healthcare economy.”