Number of prescribed antibiotic items from cephalosporin, quinolone and co-amoxiclav class - ICB

The total number of prescribed antibiotic items per STAR-PU. STAR-PU is weighted units to allow comparisons adjusting for the age and sex of patients distribution of each general practice, aggregated to Integrated Care Boards (ICBs).A lower items per STAR-PU value is associated with fewer items of antibiotics being prescribed. ## Rationale The consumption of antibiotics is a major driver for the development of antibiotic resistance (AMR) in bacteria. AMR is a serious and growing global public health concern with implications for every government and the populations they serve. The emergence and spread of infections caused by bacteria that are resistant to treatment by current antibiotics strikes at the heart of modern medical and veterinary practice. The use of antibiotics is essential for saving lives in conditions such as sepsis. The UK government released a [report in 2013] and a [report in 2019], with ambitions to reduce UK antimicrobial use in humans by 15% by 2024. ## Definition of numerator Total number of antibiotic items prescribed in primary care settings. The data for the indicator is based on four 3-month rolling figures that are used to generate a rolling 12-month data point. General practice counts of items are aggregated to ICBs. An item is an antibiotic (from British National Formulary Section 5.1) that is prescribed in a primary care setting. A prescription item refers to a single item prescribed by a prescriber on a prescription form (known as an FP10). If a prescription form includes three medicines, it is counted as three prescription items. The number of items is a measure of how often a prescriber has decided to write a prescription. It is often used when we wish to look at prescriber behaviour as every prescription is an opportunity to change treatment. For vaccinations and acute treatment (for example, a short course of antibiotics), the item is also a reasonable measure of the number of courses of treatment. ## Definition of denominator The data for the indicator is based on four 3-month rolling figures that are used to generate a rolling 12-month data point. STAR-PU is weighted units adjusted by the age and sex of patient distribution of each practice. The weightings are derived from an anonymised random sample of approximately 800,000 patients registered with about 90 General Practices. They are calculated by extracting and analysing the cost or volume of prescribing by specific age groups and gender. ## Caveats STAR-PU data is inappropriate to use at any smaller level than total prescribing, i.e., individual drug class level. STAR-PU data only includes antibiotics that are administered orally. Orally administered derivatives of BNF 5.1 codes account for more than 99.8% of all prescribed items. Antibiotic items are only included in the numerator if they have a BNF 5.1 antibacterial code. Figures will vary if compared to similar indicators at different geographical levels as they are separate and have different criteria for inclusion and exclusion. Figures are aggregated to the ICBs level and may be missing due to GP not being matched to an ICB. Figures are updated, for example, to take into account merging with another provider or boundary changes.