Skin Infections and Antibiotic Prescribing: a Comparison of Surveillance and Prescribing Data

Background: Reductions in the number of dispensed antibiotics and the incidence of respiratory infections presented to GPs and have been reported. Whether this trend applies to skin infections requires further investigation.

Aim: To examine trends in the incidence of skin infections in relation to trends in dispensed prescriptions for flucloxacillin, topical fusidic acid, mupirocin, and corticosteroids with fusidic acid.

Design Of Study: Population-based analysis of patients presenting to GPs (1999-2005) contrasted with national prescribing data.

Setting: A sentinel practice network covering a population of 700,000 in England and Wales.

Method: Quarterly incidence rates of skin infections and of impetigo reported over the years 1999-2005 were compared with quarterly data on dispensed prescriptions reported by the Prescription Pricing Authority for England.

Results: In children (aged 0-14 years) the incidence of skin infections decreased slightly between 1999 and 2003 and more sharply from 2004 to 2005. In adults (aged > or =15 years) incidence was reasonably constant from year to year. In every year examined, and in both age groups, there were autumnal incidence peaks. There were annual increases in dispensed prescriptions for flucloxacillin capsules, but there was little change in the use of flucloxacillin syrups and topical antibiotic prescriptions. All prescribing data sets showed increases in the third quarter: topical corticosteroids with fusidic acid were prescribed more frequently in summer than winter.

Conclusion: In spite of slight reductions in the incidence of skin infections, flucloxacillin capsule-dispensed prescriptions have increased, suggesting that doctors have not limited their antibiotic prescribing behaviour for skin conditions.