Antibiotic prescribing trends for respiratory infections in children <16 years in England; 2016-2023

Abstract Background Judicious antibiotic prescribing in primary care is key to combating antimicrobial resistance. The covid-19 pandemic led to changes in healthcare provision with an increase in remote consultations, and changes in incidence of respiratory tract infections (RTIs). General practitioners (GPs) in England may have increased prescribing to reduce bacterial infection risk in children. We examined trends in antibiotic prescribing for RTIs in children <16 years in England from April 2016 to March 2023. Methods We used electronic health records from a nationally representative primary care database. Outcomes were monthly antibiotic prescription rates for RTIs, and the proportion of RTI consultations resulting in an antibiotic prescription. We described all outcomes by age: 0-<5, 5-<10 and 10-<16 years. Results There were 1.9 million antibiotic prescriptions issued to 4.8 million children <16 years. Mean monthly antibiotic prescription rates for RTIs fell by ∼9% per year from 1035/100 000 children in 2016/17 to 774/100 000 in 2019/20. In 2020/21, rates fell by 70% and remained lower in 2021/22. In 2022/23 rates slightly exceeded pre-pandemic levels, due to a spike in December 2022, coinciding with a streptococcal group A outbreak. Differences varied by age; in 2022/23, rates for children aged 10-<16 were 6% lower than pre-pandemic, while those for children aged 5-<10 were 25% higher. From 2016/17-2019/20, 35 prescriptions were issued per 100 RTI consultations, with an increase post-pandemic. The largest increase was among children 10-<16 years, with an increase of 34% in 2022/23 to 56 per 100 consultations. Conclusions Antibiotic prescription rates for the 2022/23 post-pandemic period increased compared with pre-pandemic, with more consultations resulting in prescriptions, particularly for children aged >10 years. This may reflect GP concerns about the severity of RTIs or rising bacterial infections. Trends should be monitored for the impact on antimicrobial resistance. Key messages • Mean monthly antibiotic prescription rates in primary care for respiratory tract infections have increased post-pandemic, particularly among children aged 5 to < 10 years. • Prescribing patterns may reflect cautious prescribing from general practitioners or changes in the incidence of respiratory tract infections post-pandemic.