6698 Trends in antibiotic prescribing for respiratory infections in children under 5 years in England from 2016 to 2023

Objectives Judicious antibiotic prescribing in primary care for respiratory tract infections (RTIs) is encouraged, as many RTIs are self-limiting. Despite this, half of all RTI consultations typically result in an antibiotic prescription. Due to changes in healthcare provision during the covid-19 pandemic, general practitioners in England may have increased prescribing behaviour to minimize the risk of bacterial infections in children. Young children in particular may have been more likely to get antibiotics, yet in the absence of an underlying long-term condition, this group is unlikely to have a serious bacterial infection. We aimed to examine trends in antibiotic prescribing in RTIs for children <5 years in England from 1 April 2016 to 31 March 2023. Methods We used electronic health records from a nationally representative primary care database. Our main outcome was annual antibiotic prescription rates for RTIs, calculated by summing the number of prescriptions given during a RTI consultation divided by the number of days each child was registered with the GP practice for each fiscal year. We also examined the proportion of RTI consultations resulting in an antibiotic prescription. Results There were 2 894 539 children <5 years registered with a primary care practice during the study period and 960 414 antibiotic prescriptions issued for RTIs. From 2016/2017 – 2019/2020 annual antibiotic prescription rates for RTIs dropped steadily by ~9% per year from 310 per 1000 child-years in 2016/2017 to 237 per 1000 child- years in 2019/2020. In 2020/2021, antibiotic prescription rates for RTIs fell dramatically by 76%, but rates increased to almost pre-pandemic levels in 2021/2022 and continued to rise in 2023. The proportion of children under 5 years who were issued an antibiotic during a RTI consultation was stable from 2016/2017 – 2020/2021 at ~29 per 100 RTI consultations but appears to have a recent upturn. (Compared with pre-pandemic, the number of antibiotic prescriptions issued per RTI consultation increased ~9% in 2021/2022 to 32 per 100 consultations and increased ~34% in 2022/2023 to 39 per 100 consultations.) Conclusion Annual antibiotic prescription rates for RTIs dropped during the pandemic against a background of steady decline, but rates are concerningly rising again. The impact of increased antibiotic prescribing for RTIs on antimicrobial resistance and future prescribing patterns needs further monitoring.