Work

Antimicrobial Consumption in England, 2019 to 2024: ESPAUR Report 2024-25

Year: 2026

Type: article

Abstract: Introduction By 2029, the UK’s 2024-2029 National Action Plan for Antimicrobial Resistance (AMR) aims to reduce total human antimicrobial consumption by 5% from a 2019 baseline,1 as well as increase the proportion of Access antibiotics (AWaRe UK 2024 classification).2 Chapter 3 of the 2024-2025 ESPAUR Report provides an overview of national antimicrobial use surveillance.3 Methods Antimicrobial use data were obtained from the NHS Business Services Authority ePACT2 (primary care) and IQVIA (secondary care and independent sector). Defined Daily Doses (DDDs) were calculated using the WHO ATC/DDD Index (2019), for antibiotics in ATC group J01 and oral agents used for Clostridium difficile infection (fidaxomicin, metronidazole, tinidazole, vancomycin). Full methods are available in the ESPAUR 2024-25 report annex.4 Results In England, total NHS antibiotic consumption in 2024 was 17.5 DDDs per 1,000 inhabitants per day (DIDs), a 2% reduction compared with 2019 levels (17.9 DIDs), the pre-pandemic baseline. Consumption increased by 0.9% from 2023, suggesting a stabilisation of prescribing following pandemic-related disruptions. Regional variation persisted, with the highest consumption in the North East (20.3 DID) and lowest in London (14.7 DID). Penicillins remained the most used antibiotic group across care settings (Figure 1). Most antibiotic classes remained below 2019 levels, however first- and second-generation cephalosporins (+0.028 DID, +11.9%), anti-C. difficile agents (+0.005 DID, +114.1%; in line with higher infection rates),5,6 sulfonamides and trimethoprim (+0.034 DID, +4.4%), and other antibacterials (+0.48 DID, +29.9%, reflecting increased methenamine use as an antibiotic-sparing agent) exceeded the baseline. Quinolone prescribing declined 23.2% since 2019, consistent with the Medicine and Healthcare Products Regulatory Agency guidance.7,8 Figure 1.Total NHS antibiotic consumption by antibiotic group and setting, expressed as DID, England, 2019 to 2024. The proportion of Access antibiotics surpassed 2019 levels. A slight decline between 2023 and 2024 (64.1% to 63.2%) was driven by reduced primary care prescribing (in DID) and an increased use of antibiotics classified as ‘Other’ (2.7% to 4.0%), largely related to methenamine. General practice (GP) accounted for 70.4% of antibiotics prescribed in 2024 (12.3 DID), down from 71.7% (12.6 DID) in 2023, followed by hospital inpatients (13.7%), outpatients (6.6%), other community settings (6.0%, an increase from 4.7% in 2023 following the 2024 launch of the NHS England Pharmacy First service) 9 and dental practices (3.2%) (Figure 2). Primary care antibiotic use increased slightly from 2019 when measured as items per 1,000 inhabitants per day but declined by DID, indicating smaller quantities per prescription. GP and dental prescribing fell below 2019 levels, while ‘other community’ use increased (0.11 to 0.18 items per 1,000 inhabitants/day), reflecting adoption of Pharmacy First.Figure 2.Total NHS antibiotic consumption by setting, expressed as DID, England, 2019 to 2024. Nitrofurantoin dispensed under the Pharmacy First service increased during 2024, peaking at 284 items per 100,000 population in December, while GP prescribing declined, suggesting a shift in uncomplicated urinary tract infection management to community pharmacies. Independent sector antibiotic use increased from 3.47 DID in 2019 to 5.71 DID in 2024 (+64.5%), driven mainly by non-NHS prescriptions dispensed in community pharmacies. For comparison, NHS primary care accounted for 13.96 DID, while private prescriptions dispensed in community pharmacies was 3.93 DID, representing 22% of total primary care prescribing (Figure 3).Figure 3.Antibiotic consumption through private (non-NHS) routes. Permission for use granted by UKHSA ESPAUR team. Conclusions Total NHS prescribing decreased by 2% in England in 2024 compared to 2019. Continued surveillance across all healthcare sectors is essential to guide interventions and monitor progress in reducing inappropriate antimicrobial use.

Source: JAC-Antimicrobial Resistance

DOI: 10.1093/jacamr/dlaf243.002