Antibiotic prescribing in UK general practice fell below predicted rates between April and September 2020, reaching a minimum in May, finds a population-based cohort study funded by the Biomedical Research Centre (BRC) at Guy’s and St Thomas’ NHS Foundation Trust.

The CPRD GOLD database of anonymised electronic health records, representative of patients in general practices across the country, was used to analyse trends in antibiotic prescribing and consultations for common bacterial infections during the COVID-19 pandemic.

The initial months of the pandemic were associated with increased antibiotic prescribing, which then fell below expected levels during the national lockdown. The study found that rates of GP attendances for respiratory tract infections (RTIs) and urinary tract infections (UTIs) declined substantially across the pandemic period, particularly among younger age groups.

There were very small reductions in the proportion of RTI consultations with antibiotics prescribed and no reductions for the proportion of UTI consultations with antibiotics prescribed. This is consistent with the downturn in infection consultations being the main driver of reduced antibiotic prescribing.

It was also noted that among the almost 26,000 patients with suspected or confirmed COVID-19 in the database from January to September 2020, only 11% were prescribed antibiotics. Considering that the prescribing rate for respiratory infections is typically 50%, this suggests that widespread, indiscriminate antibiotic prescribing was not taking place.

Antibiotic prescribing in primary care accounts for 70% of medical antibiotic use and is considered a significant driver of antimicrobial resistance. Over the last decade a concerted and multifaceted effort has been made to reduce unnecessary and inappropriate antibiotic prescribing in primary care.

Lead author of the study, Dr Emma Rezel-Potts, Research Associate from King’s College London said: “It was thought that the pandemic might be associated with heightened antibiotic prescribing because of a rise in patients presenting with respiratory symptoms. These findings are reassuring that antibiotic stewardship priorities have not been neglected because of COVID-19.

“Further to the direct effects of the COVID-19 pandemic on population health, it also triggered unprecedented changes in healthcare seeking behaviour, social interactions and general practice operations. There could be several factors that have led to lower prescribing rates and it is not possible to identify the causal link through this study.

“Going forward, it will be important to establish whether the effects of reduced RTI and UTI primary care consultations include increased incidence in serious bacterial infections. Further research should consider if patients were calling NHS 111 or attending COVID-19 health hubs instead of their GPs. We must continue to monitor rates of antibiotic prescribing, particularly as we enter a phase of high COVID-19 transmission and reduced lockdown restrictions.”

The full study can be found on the British Journal of General Practice website.