Optimising Antibiotic Use in Primary Care
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- Christianne Micallef
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This article is part of a series: Guest Blogs
- High Dose Dexamethasone
- How I use OpenPrescribing in my practice as a GP
- Conducting Research Using OpenSAFELY: My Experience of the Co-pilot Service
- Using electronic health records and open science in the COVID-19 pandemic
- Exploring the Impact of COVID-19 on common infections: Treatment Pathways, Antibiotic Prescribing, and Exposure
- Incidence and management of inflammatory arthritis in England before and during the COVID-19 pandemic
- Updates of OpenSAFELY Research on COVID-19 Therapeutics
- Understanding Repeat Antibiotic Prescribing in the Pandemic: Insights On Health Inequalities
- Trends in inequalities in avoidable hospitalisations across the COVID-19 pandemic
- Prescribing of Lidocaine Plasters
- The safety of antivirals and neutralising monoclonal antibodies used in prehospital treatment of Covid-19
- Investigating weight gain and obesity with OpenSAFELY
- Optimising Antibiotic Use in Primary Care
In this guest blog, Dr Christianne Micallef explains how she uses OpenPrescribing in her roles as a Lead Antimicrobial Stewardship Pharmacist at Cambridgeshire & Peterborough Integrated Care Board.
Antimicrobial Stewardship
Antimicrobial resistance (AMR) – where bacteria and other microbes develop the ability to withstand the effects of the medicines used to treat them - has been listed as one of the top 10 global health threats facing humanity. Antimicrobial stewardship (AMS) involves a series of strategies and processes designed to ensure appropriate and optimal use of antimicrobials. Effective AMS is crucial in combating the spread of AMR and ensuring the preservation of the current antimicrobial agents we currently rely on, in order to provide high-quality medical care.
My role as an Integrated Care Board (ICB) lead AMS pharmacist in Cambridgeshire & Peterborough ICB requires regular monitoring and analyses of antibiotic data trends, with prompt feedback and support to both primary care and hospital clinicians on their performance.
Hospital teams have multidisciplinary AMS teams in-situ, comprised of consultant medical microbiologists/infectious disease physicians and AMS pharmacy teams. This follows national guidance in England on the composition of AMS teams in hospitals. These teams are hospital-focused as they support the management of more complex or severe infections, often requiring intravenous antibiotics. They provide expert advice on antimicrobial choice, dosing, monitoring and diagnostics.
However, it is important to highlight that the majority of antibiotics (> 70%) in England are prescribed in primary care, so support and timely feedback to primary care prescribers is essential. In primary care, the medicines optimisation teams in ICBs provide support and feedback to GP practices on AMS. They do this by providing retrospective antibiotic consumption data and providing regular AMS-related documentation, including safety news, newsletters and educational forums.
How OpenPrescribing can help
OpenPrescribing is a free, open-access platform that enables users to explore NHS primary care prescribing data across England. It requires no registration or subscription, providing easy access to detailed insights on prescribing patterns including specific pre-curated AMS measures that provides granular insights into antibiotic prescribing within General Practice (GP) surgeries.
As an AMS lead, I regularly access the OpenPrescribing antimicrobial stewardship measures for my ICB, NHS Cambridgeshire and Peterborough and navigate to the trends specifically for:
- Broad-spectrum antibiotic prescribing rates
- Fluoroquinolone items per 1000 patients
- Shorter duration course lengths for amoxicillin & doxycycline
- Volume of antibiotics being prescribed.
When viewing the measures, I compare my ICB (red line) to the national median (dashed dark blue line) and to other ICBs across England. The lighter dotted blue lines show the distribution of ICB performance, divided into deciles. The top line represents the 90th percentile (9th decile), meaning only 10% of ICBs have higher values. The lowest line represents the 10th percentile (1st decile), meaning only 10% of ICBs have lower values.
The screenshot of the measure below demonstrates the success our ICB has achieved in reducing the number of courses of amoxicillin prescribed that are longer than 5 days. Our rates have changed from being among the top 20% in the country in September 2024, to matching the national median in April 2025. We have achieved this by employing a strategy with the following main components:
- Education & training initiatives for GP practice clinical colleagues (including GPs, pharmacy & nursing staff and non-medical prescribers)
- Production and dissemination of a monthly suite of AMS resources including retrospective data with visual aids, safety information and AMS newsletters
- Targeted support to outlier practices with in-person/virtual visits to discuss appropriate strategies/action plans
- Designing & promoting innovative quality improvement initiatives, also working jointly with other ICS providers i.e. hospitals and other NHS partners
I also access individual practice data by clicking through on “Split the measure into charts for individual practices". This can highlight outlier practices that may benefit from targeted support. In the example below, the practice on the left shows minimal change over time, while the one on the right demonstrates a sudden and significant improvement.
Targeted support typically involves visiting the GP practice, explaining how their prescribing rate compares to peers by sharing relevant charts and links from OpenPrescribing. I then work with the GPs and practice pharmacy teams, to develop supportive action plans, tailored to the individual GP practice and their local needs as a one-size approach does not fit all, especially when looking at health inequalities.
We also encourage colleagues based in practices to regularly access their own practice data via OpenPrescribing, and to sign up for the OpenPrescribing monthly alerts (example shown below) so they can continue to track their own progress.
To date, all the GP practices visited, either in-person or virtually have demonstrated improvement in their local AMS metrics with all of them decreasing their overall antibiotic consumption and the majority also decreasing broad-spectrum antibiotic usage with several currently achieving the broad-spectrum target. For the last year our ICB has been delivering the broad-spectrum and started delivering the amoxicillin shorter-duration targets following one of our targeted QI initiatives and we continue to consistently decrease our overall total antibiotic prescribing.
Summary
Christianne has detailed how she regularly uses OpenPrescribing within her ICB as part of antimicrobial stewardship activities.
You might find these OpenPrescribing resources helpful to promote antimicrobial stewardship in your own organisation:
- Antimicrobial stewardship measures for your organisation
- OpenPrescribing Antimicrobial Stewardship webinar
- OpenPrescribing monthly email alerts
If you are interested in antimicrobial stewardship in hospitals, keep an eye on OpenPrescribing Hospitals where we plan to add antimicrobial stewardship measures soon.