Differences in prescription for impetigo and cellulitis across years in three European countries

Cellulitis and impetigo account for many outpatients' visits and antibiotic prescriptions. They are mainly caused respectively by Streptococcus spp. and Staphylococcus aureus. French guidelines recommend amoxicillin as a first-line antibiotic for cellulitis and pristinamycin for severe impetigo, whereas the UK guidelines recommend flucloxacillin for both infections and no Belgian guidelines are published.

To investigate the prescription patterns of cellulitis and impetigo in general practice and to assess the potential impact of the implementation of national guidelines.

We used a prescription software database (Cegedim) from 2013 to 2023 in France, the UK and Belgium. The annual rate of antibiotic prescription associated with cellulitis and impetigo was assessed. A segmented linear regression was performed to assess the impact of the implementation of the guidelines in 2019.

The use of amoxicillin for the diagnosis of cellulitis increased from 18.2% to 36.2% in France. Flucloxacillin use increased from 41.1% to 51.6% in the UK. In Belgium, no change in antibiotic use was observed with amoxicillin-clavulanate being the most commonly prescribed antibiotic.In France, the use of pristinamycin and amoxicillin-clavulanate for the diagnosis of impetigo increased from 13.8% and 22.2% to 21.1% and 33.1%, respectively. In Belgium and the UK, flucloxacillin was the most commonly prescribed antibiotic, with prescription rates increasing from 55.7% to 62.6% and from 71.8% to 82.6%, respectively.Publication of guidelines did not affect antibiotic prescribing patterns.

Prescribing patterns are very heterogeneous across European countries and publication of guidelines did not affect prescribing habits.