Priority Areas - Stewardship: Total Antibacterial Items

The widespread and often excessive use of antimicrobials is one of the main factors contributing to the increasing emergence of antimicrobial resistance.

The introduction of NPIs for antimicrobials supports the UK Government ambitions to reduce healthcare associated infections and antimicrobial resistance.

In support of these ambitions, the Welsh Government published a Welsh Health Circular in May 2018 detailing their antimicrobial resistance improvement goals.

These included health board specific improvement goals to reduce healthcare associated infections in addition to improvement goals related to antimicrobial prescribing, using this National Prescribing Indicator as one of the markers. 


  • The widespread and often excessive usage of antimicrobials is one of the main factors contributing to the emergence of antimicrobial resistance.
  • Despite reductions in prescribing, there is variation between health boards and GP practices. In addition, prescribing in Wales is high in comparison with England.
  • Indiscriminate or inappropriate use of antibiotics is a key driver in the spread of antibiotic resistance.

 Trend in total antibacterial prescribing


Total antibacterial items per 1,000 STAR-PUs – Quarter ending September 2019

How can changes be made?

  • Where an antimicrobial is indicated, follow local or national guidelines, prescribing antibiotics for the shortest effective course at the most appropriate dose.
  • Consider the risk of antimicrobial resistance for individual patients and the population as a whole.
  • Document and code the clinical diagnosis and reason for prescribing, or not prescribing, an antimicrobial.
  • Consider a delayed/back up prescription.
  • Provide patients with leaflets/resources so they are aware of how long they can expect their condition to last and how they can self-care. Resources are available in the TARGET Antibiotics toolkit.
  • Carry out the AWMSG National Audit: Focus on Antibiotic Prescribing.



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