Indications for GP antibiotic prescribing and prescription-dispensing concordance, France, 2017-2019

Background

Antimicrobial resistance (AMR) is a major public health challenge driven by inappropriate antibiotic use. In France, antibiotic consumption remains among the highest in Europe, with general practitioners (GPs) being key outpatient prescribers. This study described the diagnostic indications for GP antibiotic prescribing and assessed concordance between number of defined daily doses (DDDs) prescribed and dispensed during 2017–2019.

Methods

Oral systemic antibiotic prescriptions for patients ≥15 years were extracted from the representative IQVIA-EMR-LPD database (2017-2019) and matched to outpatient reimbursement data from the French National Health Data System. Patient, GP, and prescription characteristics were summarized, antibiotic use by indication visualized, and differences between prescribed and dispensed DDDs assessed.

Results

A total of 925,271 prescriptions from 1,349 GPs (63.3% male, mean age 53 years) were identified for 448,140 patients (60.2% female, mean age 48 years). Upper respiratory tract infections (URTIs) were the leading indication (29.1%), followed by lower respiratory tract infection (LRTIs; 22.6%) and urinary tract infections (UTIs; 14.1%). Beta-lactams and macrolides predominated for URTIs/LRTIs, quinolones for UTIs, and tetracyclines/macrolides for skin and soft tissue infections. Overall, half of antibiotics showed prescription-dispensing discrepancies, with over-dispensing in 46% of beta-lactam and 43% of macrolide prescriptions (representing 46% and 24% of total use, respectively) and averaging +2.5 DDDs per dispensation.

Conclusions

Linking primary care prescribing data with national dispensing records is feasible and provided valuable insights for GP-led antibiotic stewardship. Excess dispensing may reflect drug storage or self‑medication, while lower dispensing could indicate incomplete treatment courses. Improving prescription-dispensing concordance should be a key stewardship target.

Key messages

• Linking GP prescribing with national dispensing data reveals key antibiotic use patterns and frequent mismatches between prescribed and dispensed defined daily doses.

• Excess dispensing of prescribed antibiotics suggests over-medication or drug storage, highlighting a key target for improved antibiotic stewardship.