Antibiotic stewardship: courses for doxycycline 100mg greater than 6 capsules/dispersible tablets

Below are the database queries which are used to create this measure. These are run against a copy of the BSA prescribing data which we store in Google BigQuery. We're working on making our BigQuery tables publicly available at which point it will be possible to run and modify these queries yourself. But even where code and database queries are not directly useable by others we believe it is always preferable to make them public.

Description Proportion of prescription items of doxycycline 100mg capsules with quantity greater than 6 capsules/dispersible tablets
Why it matters The most common indication for the prescribing of doxycycline in primary care is the treatment of respiratory-tract infections. NICE guidance recommends five-day courses when antibiotics are indicated for sinusitis, sore throat, COPD infective exacerbation, cough (acute), pneumonia (community-acquired) and otitis media. For doxycycline this would be 200mg on the first day, then 100mg once a day for 4 days (5-day course in total) requiring a total of 6 capsules/dispersible tablets. Where greater than 5 days treatment is prescribed for these indications, this increases both the unnecessary exposure to antibiotics, as well as cost. There are some indications which require higher doses/longer durations of doxycycline, e.g. treatment of infected leg ulcers.

NHS England National Medicines Optimisation Opportunities for 2023/24 identify use of the shortest effective antibiotic courses as an area for improvement.
Tags Antimicrobial Stewardship, Standard, Infections, NICE, National medicines optimisation opportunities
Implies cost savings No
Authored by christopher.wood
Checked by richard.croker
Last reviewed 2023-09-11
Next review due 2025-09-11
History View change history on GitHub →

Numerator SQL

SELECT
     CAST(month AS DATE) AS month,
     practice AS practice_id,
     SUM(items) AS numerator
 FROM hscic.raw_prescribing_normalised
 WHERE (bnf_code LIKE '0501030I0%AB' or bnf_code LIKE '0501030Z0%AB') AND quantity_per_item > 6 --Doxycycline 100mg capsules or Doxycycline 100mg dispersible tablets (brands and generic)
 GROUP BY month, practice_id

Denominator SQL

SELECT
     CAST(month AS DATE) AS month,
     practice AS practice_id,
     SUM(items) AS denominator
 FROM hscic.raw_prescribing_normalised
 WHERE (bnf_code LIKE '0501030I0%AB' or bnf_code LIKE '0501030Z0%AB') --Doxycycline 100mg capsules or Doxycycline 100mg dispersible tablets (brands and generic)
 GROUP BY month, practice_id
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