Trends in antibiotic prescribing by general practitioners in Belgium (2014-2023) and association with changing...

General practitioners (GPs) account for most antibiotic prescriptions in the community. GP age and sex may influence prescribing, particularly in the context of demographic shifts in the GP workforce. We aimed to assess trends in antibiotic prescribing by GPs in Belgium and associations between GP age and sex with prescribing volume and quality.

A retrospective analysis on nationwide administrative health data was conducted. Aggregated data on reimbursed systemic antibiotics (Anatomical Therapeutic Chemical J01) prescribed by GPs (2014-2023) were linked to the insured population (2014-2023), GP demographics (2014-2022) and consultation data (2014-2022). Volume was measured using population-based indicators: defined daily doses (DDD) and packages per 1000 beneficiaries per day (DBD and PBD) and prescriber-based indicators (DDD per GP, DDD and packages per consultation). Quality was evaluated using the proportion of amoxicillin among amoxicillin plus amoxicillin/clavulanate and the broad- to narrow-spectrum antibiotic ratio. Trends were analysed using Pearson correlations; associations using multivariable linear mixed models.

Between 2014 and 2023, antibiotic volume decreased across all population-based indicators, with DDD, DBD and PBD decreasing by 16%, 19% and 18% (P < 0.01). Prescriber-based indicators also decreased between 2014 and 2022, with DDD per GP and packages per consultation declining by 27% and 40%, respectively (P < 0.01). Quality improved, with a 34% decrease in broad-to-narrow ratio and a 14% increase in the proportion of amoxicillin. Older and male GPs had higher volumes and less favourable quality indicators.

Antibiotic prescribing by Belgian GPs declined over the past decade, but differences by GP age and sex suggest opportunities for targeted antimicrobial stewardship.