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Antimicrobial Dispensing in Primary Care in Wales (2006 – 2008)

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Antimicrobial Dispensing in Primary Care in Wales (2006 – 2008) National Public Health Service for Wales Antimicrobial Dispensing in Primary Care in Wales Antimicrobial Dispensing In Primary Care in Wales (2006 – 2008) Authors: Maggie Heginbothom Date: Status: Final Robin Howe 18/11/09 Report entitled ‘Antimicrobial Dispensing Welsh Antimicrobial Resistance Programme: in Primary Care in Wales’ Surveillance Unit Executive Summary This is the first report from the Welsh Antimicrobial Resistance Programme Surveillance Unit regarding antimicrobial usage in primary care, and is aimed at providing an overview of antimicrobial prescriptions prescribed by general practices and dispensed in primary care in Wales Key points of note are: Antimicrobial usage in primary care in Wales is common In 2008, there were 2,417,104 antimicrobial prescription items dispensed. This equates to almost 1 antibiotic for every member of the population. Antimicrobial use has increased from 2006 Between 2006 and 2007 antimicrobial dispensing increased from 538.9 to 570.2 prescriptions/1000 PUs* (5.8% increase). However, from 2007 to 2008 there was little change in the All-Wales dispensing rate. Antimicrobial use, in terms of amount, varies between Local Health Boards (LHBs) In 2008, dispensing varied from 487.9 prescriptions/1000 PUs per annum to 659.5 prescriptions/1000 PUs per annum. Antimicrobial use, in terms of agents selected, varies between Local Health Boards (LHBs) For example, the percentage use by LHBs of different oral tetracyclines was: oxytetracycline 20-49%, doxycycline 15-48%, lymecycline 5-33%, and minocycline 7-16%. The proportion of total dispensing of antimicrobials that are included in the “Top 9” (amoxicillin, clarithromycin, doxycycline, erythromycin, flucloxacillin, nitrofurantoin, oxytetracycline, penicillin V and trimethoprim) ranged from 70-79%. The commonest antimicrobial used is amoxicillin, presumably for the treatment of respiratory tract infections. In 2008, dispensing varied from142.9 prescriptions/1000 PUs per annum to 240.5 prescriptions/1000 PUs per annum. The length of antimicrobial prescription courses does not always correlate with National recommendations. This is likely to be partly due to configuration of computer systems in primary care. HPA recommendations for the treatment of uncomplicated UTI in women suggest a 3-day course of trimethoprim; in 2008 26.1% of prescriptions for trimethoprim 200mg capsules were for 3 days. * PU (Prescribing Unit) – an age-adjusted measure of population i Table of Contents Section 1: Introduction ........................................................................................... 1 Background ........................................................................................................... 1 Collation and Presentation of Antimicrobial Dispensing Data................................. 1 Data Interpretation................................................................................................. 3 Section 2: Antimicrobial Dispensing Data............................................................. 4 All-Wales dispensing by antimicrobial group 2006-2008 ........................................ 4 Local Health Board dispensing rates by antimicrobial group 2006-2008 ................ 6 All-Wales Dispensing of Top 9 Antimicrobials ...................................................... 28 LHB by Area - Dispensing of Top 9 Antimicrobials............................................... 30 Section 3: Detailed Description of Antimicrobial Use......................................... 33 Penicillin Group ................................................................................................... 33 Amoxicillin Dispensing by Dosage and Duration .................................................. 37 Cephalosporin Group........................................................................................... 40 Macrolide/ Lincosamide/ Streptogrammin Group ................................................. 42 Tetracycline Group .............................................................................................. 44 Fluoroquinolone Group ........................................................................................ 46 Trimethoprim/Sulfonamide Group ........................................................................ 48 Trimethoprim Dispensing by Dosage and Duration .............................................. 49 ii Section 1: Introduction Background Welsh Antimicrobial Resistance Programme Surveillance Unit This is the first report from the Welsh Antimicrobial Resistance Programme Surveillance Unit regarding antimicrobial usage in primary care, and is aimed at providing an overview of antimicrobial prescriptions prescribed by general practices and dispensed in primary care in Wales. Collation and Presentation of Antimicrobial Dispensing Data Data sources Antimicrobial prescribing data was provided by the Prescribing Services Unit (PSU). PSU is part of Health Solutions Wales (HSW), a division of Velindre NHS Trust. PSU is responsible for calculating the remuneration due to community pharmacies, dispensing doctors, appliance contractors and GPs who personally administer drugs for issuing prescribed items against NHS prescriptions. The data collected during this process is also used to drive a range of information products that are provided to stakeholders across the NHS and, where applicable, made publicly available. Data is collected from prescriptions that are submitted to PSU by dispensing contractors at the end of each month. Data is collected only from prescriptions that have actually been dispensed. Data is allocated to Local Health Boards on the basis of where the item is prescribed. References to “dispensed” items should therefore be read as items dispensed by community dispensing contractors against prescriptions written in the referenced Local Health Board. Data presentation In general, data in the report is expressed as scripts/1000PU or DDDs/1000PU collated at the level of the former 22 Local Health Boards listed in Table 1. Prescriptions or “scripts” refers to an antimicrobial item that has been dispensed; please note that a prescription may contain more than one antimicrobial item. “DDD” stands for Defined Daily Dose. DDDs provide a standard measure of drug usage that can be used for international drug utilisation studies. They are administered by the WHO Collaborating Centre for Drug Statistics Methodology at the Norwegian Institute of Public Health which is linked directly to WHO Headquarters in Geneva. http://www.whocc.no/atcddd/. “PU” is an abbreviation for Prescribing Unit. PUs are an age adjusted measure of population. They are used to take account of the greater need of elderly patients for medication. Rather than compare the number of items prescribed by patient, comparison by PU weights the result according to the number of elderly patients in population. Patients aged 65 and over are counted as 3 prescribing units and patients under 65 and temporary residents are counted as 1. 1 Table 1: LHB codes Former LHBs Code Area Bridgend LHB BGD Mid & West Wales Blaenau Gwent LHB BLG South East Wales Caerphilly LHB CAE South East Wales Carmarthen LHB CAM Mid & West Wales Cardiff LHB CAR South East Wales Ceredigion LHB CER Mid & West Wales Conwy LHB CON North Wales Denbighshire LHB DEN North Wales Flintshire LHB FLI North Wales Gwynedd LHB GWY North Wales Merthyr Tydfil LHB MER South East Wales Monmouth LHB MON South East Wales Newport LHB NEW South East Wales Neath/ Port Talbot LHB NPT Mid & West Wales Pembrokeshire LHB PEM Mid & West Wales Powys LHB POW Mid & West Wales Rhondda Cynon Taff LHB RCT South East Wales Swansea LHB SWA Mid & West Wales Torfaen LHB TOR South East Wales The Vale of Glamorgan LHB VOG South East Wales Wrexham LHB WRX North Wales Ynys Mon LHB YNY North Wales For ease of interpretation and presentation, antimicrobial data has been collated into Groups as shown in Table 2. Table 2: Antimicrobial Group codes Code Antimicrobial Group Example from data set BLIC Beta Lactamase Inhibitor Combinations Co-amoxiclav BLRP Beta Lactamase Resistant Penicillins Flucloxacillin BLSP Beta Lactamase Sensitive Penicillins Penicillin V BSP Broad Spectrum Penicillins Amoxicillin CEF Cephalosporins Cefalexin MLS Macrolides, Lincosamides & Streptogrammins Erythromycin QUIN Quinolones Ciprofloxacin TET Tetracyclines Oxytetracycline TRI Trimethoprim & Sulfonamides Trimethoprim Other Other antimicrobials Metronidazole 2 Data Interpretation A number of factors should be considered when examining the data presented in this report: The data presented is for antimicrobial items that have been dispensed and therefore DO NOT necessarily correlate with antimicrobial prescriptions (e.g. delayed prescriptions that were not dispensed would not be included in the data set) or antimicrobial use (ie dispensed antimicrobial courses may not be completed by the patient). Differences in antimicrobial use between Local Health Boards may be due to many differences that have been shown to influence use including population health, population deprivation, or availability of dispensing practices. Only data for oral and parenteral antimicrobial usage are included in this report; it DOES NOT include topical, inhaled, rectal or genital preparation usage. It should be noted that PSU uses a drug database supplied and maintained by the NHS Business Services Authority, Prescription Pricing Division (PPD). This database does not have full coverage of Defined Daily Dose (DDD) allocations for all of the products contained
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