Antibiotic use in Primary care in Northern Ireland

Author(s): Naomi Hamilton and Heather M. Coleman

Research is scarce regarding antimicrobial use and antimicrobial resistance (AMR) for specific localities in Northern Ireland (NI). Additionally, the effects of COVID-19 on antimicrobial prescribing patterns and AMR are unknown. Between the European Union (EU) and United States (US), AMR causes approximately 68,000 deaths annually. An electronic survey was developed and distributed to eighty-five community pharmacists in Belfast. Yearly and monthly prescription data was gathered from the Business Services Organisation and COVID-19 statistics from Gov.uk. Over- all response rate was 46%. Most pharmacists (82%) failed to address prescriber non-compliance with guidelines and antimicrobial dosing errors (59%). The most common indication for antibiotics was upper respiratory tract infections (URTIs). Overprescribing of antibiotics was perceived as the leading cause of AMR, therefore 69% of pharmacists indicated increased General Practitioner (GP) compliance with guidelines would reduce AMR. Pharmacists’ are in an ideal position to reduce AMR through patient education however, it is demonstrated that pharmacists failed to adequately counsel patients on antibiotic use. All GP practices demonstrated inappropriate antibiotic use, especially for URTIs which suggests antibiotic appropriateness should be reviewed. Many patients avoided contact with GP’s during COVID-19 which may have resulted in reduced antibiotic use. This re- search established amoxicillin as the most commonly prescribed antibiotic, which is contributing to increased AMR with its broad-spectrum activity and has recognised a decrease in antibiotic pre- scribing during COVID-19. Based on the results found and a critical review of the literature it is recommended antimicrobial guidelines should be reviewed and improved, enhanced training should be provided to pharmacists and the antibiotic guardian (AG) campaign should be re-energised.