An examination of trends in antibiotic prescribing in primary care and the association with area-level deprivation in England

Abstract Background Internationally, there are growing concerns about antimicrobial resistance. This has resulted in increased scrutiny of antibiotic prescribing trends – particularly in primary care where the majority of prescribing occurs. In England, antibiotic prescribing targets are set nationally but little is known about the local context of antibiotic prescribing. This study aimed to examine trends in antibiotic prescribing (including broad-spectrum), and the association with area-level deprivation and region in England. Methods Antibiotic prescribing data by GP surgery in England were obtained from NHS Business Service Authority for the years 2014-2018. These data were matched with the Index of Multiple Deprivation (IMD 2015) at the Lower Layer Super Output level (LSOA). Linear regression methods were employed to explore the relationship between antibiotic use and area-level deprivation as well as region, after controlling for a range of other confounding variables, including health need, rurality, and ethnicity. Results Over time, the amount of antibiotic prescribing significantly reduced from 1.11 items per STAR-PU to 0.96 items per STAR-PU – a reduction of 13.6%. The adjusted models found that, at LSOA level, the most deprived areas of England had the highest levels of antibiotic prescribing (0.03 items per STAR-PU higher). However, broad spectrum antibiotic prescribing exceeding 10% of all antibiotic prescribing within a GP practice was higher in more affluent areas. There were also significant regional differences – with the North East and the East of England having the highest levels of antibiotic prescribing (by 0.16 items per STAR-PU).Conclusion Although antibiotic prescribing has reduced over time, there remains significant variation in by area-level deprivation and region in England – with higher antibiotic prescribing in more deprived areas. Future prescribing targets should account for local factors to ensure the most deprived communities are not inappropriately penalised.

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Coping With Diagnostic Uncertainty in Antibiotic Prescribing: A Latent Class Study of Primary Care Physicians in Hubei China

Frontiers in Public Health ◽

10.3389/fpubh.2021.741345 ◽

2021 ◽

Vol 9 ◽

Author(s):

Chaojie Liu ◽

Dan Wang ◽

Lixia Duan ◽

Xinping Zhang ◽

Chenxi Liu

Keyword(s):

Primary Care ◽

Broad Spectrum ◽

Primary Care Physicians ◽

Latent Class ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Behavioral Patterns ◽

Diagnostic Uncertainty ◽

Logistic Regression Models ◽

Broad Spectrum Antibiotics

Background: Misuse of antibiotics is prevalent worldwide and primary care is a major contributor. Although a clear diagnosis is fundamental for rational antibiotic use, primary care physicians often struggle with diagnostic uncertainty. However, we know little about how physicians cope with this situation and its association with antibiotic prescribing.Methods: A total of 583 primary care physicians were surveyed using the Dealing with Uncertainty Questionnaire. Their prescriptions (n = 949,181) over the year 2018 were retrieved retrospectively. Two categories of behavioral patterns of participants were identified based on latent class analyses (high vs. low openness and collaborativeness) in responding to diagnostic uncertainty. Multi-level logistic regression models were established to determine the associations between these behavioral patterns and antibiotic prescribing (overall and broad-spectrum antibiotics) for illness without an indication for antibiotics and those with a conditional indication for antibiotics, respectively, after adjustment for variations of patient (level one) and physician (level two) characteristics.Results: Most physicians reported open communications with their patients (80.96%), collected further information (85.08%), and referred patients to specialists (68.95%) in dealing with diagnostic uncertainly. More than half (56.95%) sought help from colleagues. Less than 20% acted on intuition or adopted a “wait and see” strategy. About 40% participants (n = 238) were classified into the group of low openness and collaborativeness in coping with diagnostic uncertainty. They were more likely to prescribe antibiotics for the recorded illness without an indication for antibiotics (AOR = 1.013 for all antibiotics, p = 0.024; AOR = 1.047 for broad-spectrum antibiotics, p < 0.001), as well as for the recorded illness with a conditional indication for antibiotics (AOR = 1.226 for all antibiotic, p < 0.001; AOR = 1.257 for broad-spectrum antibiotics, p < 0.001).Conclusion: Low tolerance with diagnostic uncertainty is evident in primary care. Inappropriate and over antibiotic prescribing is shaped by physicians' coping methods of diagnostic uncertainty. Physicians' openness and collaborativeness in responding to diagnostic uncertainty is associated with lower antibiotic prescribing in primary care. Interventions targeting on better management of diagnostic uncertainty may offer a promising approach in reducing antibiotic use in primary care.

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Trends in Antibiotic Prescribing in Out-of-Hours Primary Care in England from January 2016 to June 2020 to Understand Behaviours during the First Wave of COVID-19

Antibiotics ◽

10.3390/antibiotics10010032 ◽

2021 ◽

Vol 10 (1) ◽

pp. 32

Author(s):

Nina J. Zhu ◽

Monsey McLeod ◽

Cliodna A. M. McNulty ◽

Donna M. Lecky ◽

Alison H. Holmes ◽

...

Keyword(s):

Primary Care ◽

Time Series ◽

Patient Outcomes ◽

Broad Spectrum ◽

Antibiotic Prescribing ◽

Broad Spectrum Antibiotic ◽

Out Of Hours ◽

Broad Spectrum Antibiotics ◽

National Quality ◽

General Practices

We describe the trend of antibiotic prescribing in out-of-hours (OOH) general practices (GP) before and during England’s first wave of the COVID-19 pandemic. We analysed practice-level prescribing records between January 2016 to June 2020 to report the trends for the total prescribing volume, prescribing of broad-spectrum antibiotics and key agents included in the national Quality Premium. We performed a time-series analysis to detect measurable changes in the prescribing volume associated with COVID-19. Before COVID-19, the total prescribing volume and the percentage of broad-spectrum antibiotics continued to decrease in-hours (IH). The prescribing of broad-spectrum antibiotics was higher in OOH (OOH: 10.1%, IH: 8.7%), but a consistent decrease in the trimethoprim-to-nitrofurantoin ratio was observed OOH. The OOH antibiotic prescribing volume diverged from the historical trend in March 2020 and started to decrease by 5088 items per month. Broad-spectrum antibiotic prescribing started to increase in OOH and IH. In OOH, co-amoxiclav and doxycycline peaked in March to May in 2020, which was out of sync with seasonality peaks (Winter) in previous years. While this increase might be explained by the implementation of the national guideline to use co-amoxiclav and doxycycline to manage pneumonia in the community during COVID-19, further investigation is required to see whether the observed reduction in OOH antibiotic prescribing persists and how this reduction might influence antimicrobial resistance and patient outcomes.

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The Impact of a National Antimicrobial Stewardship Program on Antibiotic Prescribing in Primary Care: An Interrupted Time Series Analysis

Clinical Infectious Diseases ◽

10.1093/cid/ciy902 ◽

2018 ◽

Vol 69 (2) ◽

pp. 227-232 ◽

Cited By ~ 14

Author(s):

Violeta Balinskaite ◽

Alan P Johnson ◽

Alison Holmes ◽

Paul Aylin

Keyword(s):

Primary Care ◽

Time Series ◽

Broad Spectrum ◽

Interrupted Time Series ◽

Series Data ◽

Antibiotic Prescribing ◽

Segmented Regression ◽

Broad Spectrum Antibiotic ◽

Stewardship Program ◽

The Impact

Abstract Background The Quality Premium was introduced in 2015 to financially reward local commissioners of healthcare in England for targeted reductions in antibiotic prescribing in primary care. Methods We used a national antibiotic prescribing dataset from April 2013 until February 2017 to examine the number of antibiotic items prescribed, the total number of antibiotic items prescribed per STAR-PU (specific therapeutic group age/sex-related prescribing units), the number of broad-spectrum antibiotic items prescribed, and broad-spectrum antibiotic items prescribed, expressed as a percentage of the total number of antibiotic items. To evaluate the impact of the Quality Premium on antibiotic prescribing, we used a segmented regression analysis of interrupted time series data. Results During the study period, over 140 million antibiotic items were prescribed in primary care. Following the introduction of the Quality Premium, antibiotic items prescribed decreased by 8.2%, representing 5933563 fewer antibiotic items prescribed during the 23 post-intervention months, as compared with the expected numbers based on the trend in the pre-intervention period. After adjusting for the age and sex distribution in the population, the segmented regression model also showed a significant relative decrease in antibiotic items prescribed per STAR-PU. A similar effect was found for broad-spectrum antibiotics (comprising 10.1% of total antibiotic prescribing), with an 18.9% reduction in prescribing. Conclusions This study shows that the introduction of financial incentives for local commissioners of healthcare to improve the quality of prescribing was associated with a significant reduction in both total and broad-spectrum antibiotic prescribing in primary care in England.

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Antibiotic prescribing for common infections in UK general practice: variability and drivers

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz163 ◽

2019 ◽

Vol 74 (8) ◽

pp. 2440-2450 ◽

Cited By ~ 10

Author(s):

Victoria Palin ◽

Anna Mölter ◽

Miguel Belmonte ◽

Darren M Ashcroft ◽

Andrew White ◽

...

Keyword(s):

Primary Care ◽

Change Points ◽

Antibiotic Prescribing ◽

Oral Antibiotic ◽

Large Variability ◽

Targeted Interventions ◽

History Of ◽

General Practices ◽

Over Time ◽

Common Infections

Abstract Objectives To examine variations across general practices and factors associated with antibiotic prescribing for common infections in UK primary care to identify potential targets for improvement and optimization of prescribing. Methods Oral antibiotic prescribing for common infections was analysed using anonymized UK primary care electronic health records between 2000 and 2015 using the Clinical Practice Research Datalink (CPRD). The rate of prescribing for each condition was observed over time and mean change points were compared with national guideline updates. Any correlation between the rate of prescribing for each infectious condition was estimated within a practice. Predictors of prescribing were estimated using logistic regression in a matched patient cohort (1:1 by age, sex and calendar time). Results Over 8 million patient records were examined in 587 UK general practices. Practices varied considerably in their propensity to prescribe antibiotics and this variance increased over time. Change points in prescribing did not reflect updates to national guidelines. Prescribing levels within practices were not consistent for different infectious conditions. A history of antibiotic use significantly increased the risk of receiving a subsequent antibiotic (by 22%–48% for patients with three or more antibiotic prescriptions in the past 12 months), as did higher BMI, history of smoking and flu vaccinations. Other drivers for receiving an antibiotic varied considerably for each condition. Conclusions Large variability in antibiotic prescribing between practices and within practices was observed. Prescribing guidelines alone do not positively influence a change in prescribing, suggesting more targeted interventions are required to optimize antibiotic prescribing in the UK.

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Knowledge, Attitudes, and Reported Practices Among Obstetrician-Gynecologists in the USA Regarding Antibiotic Prescribing for Upper Respiratory Tract Infections

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2005/405868 ◽

2005 ◽

Vol 13 (1) ◽

pp. 17-24 ◽

Cited By ~ 14

Author(s):

Shadi Chamany ◽

Jay Schulkin ◽

Charles E. Rose ◽

Laura E. Riley ◽

Richard E. Besser

Keyword(s):

Primary Care ◽

Respiratory Tract Infections ◽

Antibiotic Use ◽

Upper Respiratory Tract Infections ◽

Antibiotic Prescribing ◽

Upper Respiratory Tract ◽

Office Visits ◽

The Common ◽

Upper Respiratory ◽

Tract Infections

Background:Knowledge, attitudes, and practices regarding antibiotic prescribing for upper respiratory tract infections (URIs) have not been well described among obstetrician-gynecologists (OB/GYNs). This information is useful for determining whether an OB/GYN-specific program promoting appropriate antibiotic use would significantly contribute to the efforts to decrease inappropriate antibiotic use among primary care providers.Methods:An anonymous questionnaire asking about the treatment of URIs was sent to 1031 obstetrician-gynecologists.Results:The overall response rate was 46%. The majority of respondents (92%) were aware of the relationship between antibiotic use and antibiotic resistance, and respondents estimated that 5% of their patients had URI symptoms at their office visits. Overall, 56% of respondents reported that they would prescribe an antibiotic for uncomplicated bronchitis and 43% for the common cold. OB/GYNs with the fewest years of experience were less likely than those with the most years of experience to report prescribing for uncomplicated bronchitis (Odds ratio (OR) 0.46, 95% confidence interval (CI) 0.23 to 0.91) or the common cold (OR 0.44, CI 0.22 to 0.89). The majority of respondents (60%) believed that most patients wanted an antibiotic for URI symptoms, with male OB/GYNs being more likely than female OB/GYNs (OR 2.1, CI 1.2 to 3.8) to hold this belief. Both male OB/GYNs (OR 1.9, CI 1.1 to 3.4) and rural practitioners (OR 2.1, CI 1.1 to 4.0) were more likely to believe that it was hard to withhold antibiotics for URI symptoms because other physicians prescribe antibiotics for these symptoms. OB/GYNs who believed that postgraduate training prepared them well for primary care management were more likely than those who did not (OR 2.1, CI 1.1 to 4.2) to believe that they could reduce antibiotic prescribing without reducing patient satisfaction.Conclusion:Multiple demographic factors affect attitudes and reported practices regarding antibiotic prescribing. However, in view of the low proportion of office visits for URIs, an OB/GYN-specific program is not warranted.

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Identifying antibiotic prescribing patterns through multi-level latent profile analyses: a cross-sectional survey of primary care physicians in Hubei of China

10.21203/rs.3.rs-16669/v1 ◽

2020 ◽

Author(s):

Dan Wang ◽

Chaojie Liu ◽

Xinping Zhang ◽

Chenxi Liu

Keyword(s):

Primary Care ◽

Broad Spectrum ◽

Primary Care Physicians ◽

Prescribing Patterns ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Latent Profile Analyses ◽

Broad Spectrum Antibiotics

Abstract Background Overuse of antibiotics significantly fuels the development of AMR, which threating the global population health. Great variations existed in antibiotic prescribing practices among physicians, indicating improvement potential for rational use of antibiotics. This study aims to identify antibiotic prescribing patterns of primary care physicians and potential determinants. Methods A cross-sectional survey was conducted on 551 physicians from 67 primary care facilities in Hubei selected through random cluster sampling, tapping into their knowledge, attitudes and prescribing practices toward antibiotics. Prescriptions (n=501,072) made by the participants from 1 January to 31 March 2018 were extracted from the medical records system. Seven indicators were calculated for each prescriber: average number of medicines per prescription, average number of antibiotics per prescription, percentage of prescriptions containing antibiotics, percentage of antibiotic prescriptions containing broad-spectrum antibiotics, percentage of antibiotic prescriptions containing parenteral administered antibiotics, percentage of antibiotic prescriptions containing restricted antibiotics, and percentage of antibiotic prescriptions containing antibiotics included in the WHO “Watch and Reserve” list. Two-level latent profile analyses were performed to identify the antibiotic prescribing patterns of physicians based on those indicators. Multi-nominal logistic regression models were established to identify determinants with the antibiotic prescribing patterns. Results On average, each primary care physician issued 909 (ranging from 100 to 11941 with a median of 474) prescriptions over the study period. The mean percentage of prescriptions containing antibiotics issued by the physicians reached 52.19% (SD=17.20%). Of those antibiotic prescriptions, an average of 82.29% (SD=15.83%) contained broad-spectrum antibiotics; 71.92% (SD=21.42%) contained parenteral administered antibiotics; 23.52% (SD=19.12%) contained antibiotics restricted by the regional government; and 67.74% (SD=20.98%) contained antibiotics listed in the WHO “Watch and Reserve” list. About 28.49% of the prescribers were identified as low antibiotic users, compared with 51.18% medium users and 20.33% high users. Higher use of antibiotics was associated with insufficient knowledge, indifference to changes, complacency with satisfied patients, low household income and rural location of the prescribers. Conclusion Great variation in antibiotic prescribing patterns exists among primary care physicians in Hubei of China. High use of antibiotics is not only associated with knowledge shortfalls but also low socioeconomic status of prescribers.

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Perceptions, Current Practices and Interventions of Community Pharmacists Regarding Antimicrobial Stewardship: A Qualitative Study in France

10.21203/rs.3.rs-1033731/v1 ◽

2021 ◽

Author(s):

Claire Durand ◽

Aude Chappuis ◽

Eric Douriez ◽

Frédérique Poulain ◽

Raheelah Ahmad ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Antimicrobial Resistance ◽

Community Health ◽

Antimicrobial Stewardship ◽

Thematic Analysis ◽

Community Pharmacists ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Community Health Care

Abstract Background: Community health care accounts for the vast majority of antibiotic use in Europe. Given the threat of antimicrobial resistance (AMR), there is an urgent need to develop new antimicrobial stewardship (AMS) interventions in primary care that could involve different health care providers including community pharmacists. This study aimed to explore the perceptions, currents practices and interventions of community pharmacists regarding antimicrobial stewardship.Methods: Semi-structured qualitative interviews were conducted with community pharmacists in France. Participants were recruited through a professional organization of community pharmacists combined with a snowballing technique. Interviews were audio recorded, transcribed and analyzed using thematic analysis. The Consolidated Framework for Implementation Research was used while developing the interview guide and carrying out thematic analysis.Results: Sixteen community pharmacists participated. All the respondents had good awareness about antimicrobial resistance and believed community pharmacists had an important role in tackling AMR. Some barriers to community pharmacists’ participation in AMS were identified such as difficult interactions with prescribers, lack of time and lack of access to patient medical records and diagnosis. Increased patient education, audits and feedback of antibiotic prescribing, increased point-of-care testing and delayed prescribing were interventions suggested by the pharmacists to improve antibiotic use in primary care. Strategies cited by participants to facilitate the implementation of such interventions are increased pharmacist-general practitioner collaboration, specialized training, clinical decision support tools as well as financial incentives. Conclusions: This study suggests that community pharmacists could play a greater role in infection management and AMS interventions. Further interprofessional collaboration is needed to optimize antibiotic prescribing and utilization in community health care.

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1135. The Effect of Penicillin Allergy Labels on Antibiotic Prescribing for Children Diagnosed with Upper Respiratory Tract Infections in Two Primary Care Networks

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1328 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S658-S659

Author(s):

Torsten Joerger ◽

Margaret Taylor ◽

Debra Palazzi ◽

Jeffrey Gerber

Keyword(s):

Broad Spectrum ◽

Respiratory Tract Infections ◽

Antibiotic Use ◽

Upper Respiratory Tract Infections ◽

Antibiotic Prescribing ◽

Second Line ◽

Upper Respiratory Tract ◽

Broad Spectrum Antibiotic ◽

Upper Respiratory ◽

Tract Infections

Abstract Background In pediatric inpatient settings, unconfirmed penicillin allergy labels (PALs) are associated with increased broad-spectrum antibiotic use, costs, and adverse events. However, 90% of antibiotics are prescribed in the outpatient setting and 70% of these antibiotics are given for upper respiratory tract infections (URTI.) Little is known about the effect of PALs on antibiotic prescribing in the pediatric outpatient population. Methods A retrospective birth cohort was created of children born between January 1st 2010 and June 30th 2020 and seen at one of 91 Texas Children’s Pediatrics or Children’s Hospital of Philadelphia primary care clinics. Children with an ICD10 code for an URTI and an antibiotic prescription were stratified into those with or without a penicillin allergy label at the time of the infection. Rates of second-line and broad-spectrum antibiotic use were compared. Results The birth cohort included 334,465 children followed for 1.2 million person-years. An antibiotic was prescribed for 696,782 URTIs and the most common diagnosis was acute otitis media. Children with PALs were significantly more likely to receive second-line antibiotics (OR 35.0, 95% CI 33.9-36.1) and broad-spectrum antibiotics (OR 23.9, 95% CI 23.2-24.8.) Children with PALs received more third generation cephalosporins (60% vs. 15%) and more macrolide antibiotics (25% vs. 3%) than those without a PAL. Overall, 18,015 children (5.4%) acquired a PAL during the study period, which accounted for 23% of all second-line antibiotic prescriptions and 17% of all broad-spectrum antibiotic use for URTIs. Multivariable logistic regression for receipt of second-line antibiotics for upper respiratory tract infections Conclusion PALs are common and account for a substantial proportion of second-line and broad-spectrum antibiotic use in pediatric outpatients treated for URTIs. Efforts to de-label children with PALs are likely to increase first-line antibiotic use and decrease broad-spectrum antibiotic use for URTIs, the most common indication for antibiotic prescribing to children. Disclosures Debra Palazzi, MD, MEd, AAP (Other Financial or Material Support, PREP ID Editorial Board, PREP ID Course)AHRQ (Research Grant or Support)Elsevier (Other Financial or Material Support, Royalties for writing and editing chapters)JAMA Pediatrics (Board Member)

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Inappropriate antibiotic use for respiratory infections in outpatient settings

Journal of Fatima Jinnah Medical University ◽

10.37018/dquy6587 ◽

2021 ◽

Vol 15 (2) ◽

pp. 67-71

Author(s):

Saman Omer ◽

Bushra Tayyaba Khan ◽

Omer Jalil ◽

Muhammad Waqar Aslam Khan ◽

Quratulain Mehdi ◽

...

Keyword(s):

Public Health ◽

Respiratory Tract ◽

Respiratory Tract Infections ◽

Respiratory Infections ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Prescribing Indicators ◽

Acute Respiratory Tract Infections ◽

Prescribing Trends ◽

Tract Infections

Background: Overuse of antibiotics is a significant problem in low- and middle-income countries where recommended treatment guidelines are not routinely practiced, resulting in antimicrobial resistance. Acute respiratory tract infections, mostly viral in origin, remain the clinical category for most commonly prescribed antibiotics. Due to the lack of local evidence about antibiotic prescribing trends in such infections, this study was conducted to evaluate the prescribing patterns in general and antibiotic prescribing trends specifically in prescriptions with the diagnosis of acute respiratory infections in district Mirpur of Azad Kashmir. Patients and methods: A prospective cross-sectional study carried out in the Department of Pharmacology and Therapeutics, Army Medical College, Rawalpindi, and outpatient departments of public health facilities in district Mirpur, Kashmir, from Aug to Oct 2020. Data were collected from 10 different public health facilities in District Mirpur, Kashmir including, three rural health centers (RHC) and five basic health units (BHU). Prescribing pattern analysis by objective observations of the prescriptions after patient-physician encounter against the World Health Organization defined core prescribing indicators. The appropriateness of antibiotic use was analyzed against clinical practice guidelines. IBM SPSS Statistics for Windows, Version 26 was used for data analysis. Descriptive analysis was done to find frequencies and percentages for categorical data and means and standard deviation for continuous data. Results: Total number of prescriptions evaluated was 144. Number of prescriptions containing antibiotics was 118 (82%) (standard, 20 - 26.8%). Inappropriate use of antibiotics was seen in 78% of cases where no antibiotics were indicated. The average number of medicines per prescription was 3.11 (standard, 2.1), whereas 79% of medicines prescribed were from the national essential medicine list (standard, 100%). Only 2.5% (standard, 100%) of the medications were prescribed with generic names. Conclusion: This study shows an inappropriate and overuse of antibiotics for acute respiratory tract infections, indicating a lack of adherence to core prescribing indicators and clinical guidelines by the physicians in outpatient clinics of Mirpur.

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264Antibiotic use associated with acute gastroenteritis in Australian primary care

International Journal of Epidemiology ◽

10.1093/ije/dyab168.272 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Wen-Qiang He ◽

Martyn Kirk ◽

John Hall ◽

Bette Liu

Keyword(s):

Primary Care ◽

Acute Gastroenteritis ◽

Treatment Guidelines ◽

Antibiotic Use ◽

Health Concern ◽

Antibiotic Prescribing ◽

Remote Areas ◽

Antibiotics Use ◽

Education And Awareness ◽

Campylobacter Infections

Abstract Background Inappropriate antibiotic use is a global health concern as it increases antibiotic resistance. Antibiotics are not routinely recommended for treating acute gastroenteritis, non-typhoidal salmonella and campylobacter infections. We investigated adherence to these recommendations in primary care. Methods We used a large electronic database of primary care records to identify presentations for acute gastroenteritis, non-typhoidal salmonella and campylobacter infections and antibiotic prescribing from 1st Jan 2013 to 31 December 2018. We estimated the proportions of cases prescribed antibiotics according to various characteristics and examined the antibiotics prescribed. Results A total of 86998, 1106, and 1952 participants were identified with acute gastroenteritis, non-typhoidal salmonella, and campylobacter infections and correspondingly 10% (8720/86998), 40% (437/1106), and 57% (1118/1952) of these cases were prescribed antibiotics in the period up to 5 days post-diagnosis. Patients residing in outer regional/remote areas and those from Northern Territory and Queensland were more likely to be prescribed antibiotics than those residing in major cities and those from other states (p < =0.04). No dominant antibiotic class was prescribed for acute gastroenteritis. Quinolones (28.6%) and macrolides (27.0%) were the most frequently prescribed antibiotics for non-typhoidal salmonella, and macrolides (69%) were the predominant antibiotics prescribed for campylobacter. Conclusion The high proportion of antibiotics dispensed in the general population with acute gastroenteritis, non-typhoidal salmonella and campylobacter infections suggests that antimicrobial stewardship needs to include better education and awareness around treatment guidelines for such infections. Key messages Antibiotics use was common for Australian population with acute gastroenteritis, particularly those with non-typhoidal salmonella and campylobacter infections.

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