Do CCGs with higher numbers of MRSA cases prescribe more antibiotics?

There’s a lot of debate about GP over-prescribing of antibiotics as possible cause of antibiotic resistance. We had a dig into the recent published data on the number of MRSA cases by CCGs in 2015 and compared it to the rates of antibiotic prescribing for the CCGs. Overall the number of recorded cases of Methicillin-resistant Staphylococcus aureus (MRSA) appears to be declining but how does this correspond to the amount of antibiotics prescribed in the community? The chart below shows the number of recorded MRSA cases by CCGs in England against their average quantity of antibiotics prescribed per script in 2015.

MRSA vs. AB Q 2015

For the individual CCGs, we mapped the rate of antibiotic prescriptions in 2015 per 1000 registered patient on the vertical y-axis versus the number of recorded cases of MRSA on the horizontal x-axis. The number of antibiotic prescriptions are taken from the GP prescribing data for the whole of 2015 and divided by the number of registered patients at the practices within that CCG.  Each dot in the diagram below represents a single CCG.

Antibiotic rx vs mrsa

The CCGs are coloured according the the NHS commissioning region for easier identification.  If higher rates of antibiotic prescribing were associated with high numbers of MRSA we would expect the dots to cluster in the top right quadrant of the chart. There are 10 CCGs which have 10 or more cases of MRSA in 2015 but have variable rates of antibiotic prescribing as shown below:

Top 10 CCGs

The map below highlights the areas where there is above average rates or antibiotic prescribing, shown in red and the white areas illustrate lower than average levels of antibiotic prescribing.

AB map

For example, many of the London CCGs have lower rates of antibiotic prescribing which may fit with their underlying younger population. To fully explain the variation in prescribing rates, we need to understand the underlying patient demographics as for example, the elderly or children may be more likely to need antibiotics and these higher rates do not necessarily lead to higher numbers of resistant cases as the figures show.

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