Prescribing of Long-term Antibiotic to Adolescents in Primary Care: a Retrospective Cohort Study

Problem

Antimicrobial resistance (AMR) is a major threat to global health as new resistance mechanisms emerge and spread globally. Unnecessary and inappropriate use of antibiotics promotes the emergence and spread of resistant bacteria. Lower doses and longer durations of antibiotic therapy are linked with increased risk of AMR. Long-term antibiotics are commonly used for the treatment of acne and prophylaxis of urinary tract infection. As acne is common in adolescence and oral antibiotics are the most common acne-related medication prescribed, we chose to determine the rates and trends and overall burden of long-term antibiotic prescriptions in an adolescent cohort in primary care in Hampshire UK.

Approach

To describe the prescribing of long-term (28 days or more) antibiotics in a cohort of 11-18 year olds, including trends over time and comparisons with acute antibiotic prescribing using primary care data for participants born between 1979 and 1996 who attended one of the GP surgeries included in the Care and Health Information Analytics database at least once during adolescence (11-18 years).

Findings

We identified 1,703,786 antibiotic prescriptions for 320,722 participants. Total antibiotic prescriptions increased from around 212 per 1000 person years in 1998 to just under 420 in 2012 and declined to around 361 in 2017. More than 15% of prescriptions were for long-term antibiotics (≥28 days). Long-term antibiotic prescribing resulted in a similar magnitude of antibiotic exposure (days of use) as acute antibiotic prescribing in this cohort.

Consequences

Adolescents’ and young adults’ exposure to antibiotics comes just as much from prescribing of long-term antibiotics as it does from prescribing of acute antibiotics. Urgent action is needed by to curtail the use of long-term antibiotics, and promote alternative management strategies.