The new report found that the intervention only led to a modest reduction in antibiotic-resistant infections from E. coli

E coli

Current strategies to reduce antibiotic prescribing in primary care in England are not enough to halt the rise in drug-resistant Escherichia coli (E. coli) infections, according to the first evaluation of NHS England’s Quality Premium intervention on antimicrobial resistance (AMR).

The new report, published in The Lancet Infectious Diseases, finds that while the intervention achieved a downward step-change in antibiotic prescribing, it only led to a modest reduction in antibiotic-resistant infections from E. coli.

The study researchers linked data from 6882 English general practices with Public Health England’s national surveillance of bacterial infections from January 2013 to December 2018 when the NHS Quality Premium was in operation. They looked at prescribing of the five most common antibiotics and examined resistance trends in E. coli infections before and after the implementation of the intervention.

GP practices prescribed an average of 207 broad-spectrum antibiotic items per 100,000 patients per month before implementation of the Quality Premium. A 13% reduction in the prescribing rate was observed immediately following its implementation, which corresponds to a reduction of 26 items per 100,000 patients in the English population. This effect was sustained such that by the end of the study period, a 57% reduction in the rate of antibiotic prescribing was observed compared with predicted rates if the intervention had not occurred.

A 5% reduction in the antibiotic resistance rate was observed immediately following the implementation of the Quality Premium, which corresponds to a reduction of 14 resistant E. coli isolates per 1000 isolates tested. 

Although this reduction was sustained until the end of the study period, E. coli resistance remains on an upward, albeit slower, trajectory.

The study’s authors conclude that a single intervention in one sector is not enough; a more radical, multisectoral approach is needed to tackle the growing threat of AMR.

This article originally appeared on Univadis, part of the Medscape Professional Network