Health Protection Scotland’s Scottish One Health Antimicrobial Use and Antimicrobial Resistance in 2017 Annual Report

Publication Date: 13 November 2018

Health Protection Scotland (HPS) has today (Tuesday 13 November) published the Scottish One Health Antimicrobial Use and Antimicrobial Resistance Report on antibiotic use and resistance in Scotland during 2017.

Dr Eleanor Anderson, Consultant Lead for the Control of Antimicrobial Resistance in Scotland programme, Health Protection Scotland, explains: "This report, published around the time of European Antibiotics Awareness Day, reminds us all that antimicrobial resistance remains a major public health issue. Antibiotics are life-saving drugs, but inappropriate use reduces our ability to treat infections. Antibiotic use and spread of infection in humans, animals and the environment all contribute to the development of antibiotic resistant infections."

Antibiotic use

The report shows a mixed picture in relation to antibiotic use in Scotland. The total use of antibiotics in humans between 2013 and 2017 decreased by 3%. In primary care, where 80% of antibiotic use occurs, there have been continued reductions in use. In 2017 the rate of antibiotic use in primary care was the lowest on record. This suggests that healthcare professionals continue to work with and reassure patients that antibiotics are not usually required for minor infections.

This shows that the work to protect the effectiveness of antibiotics in recent years has started to take effect. The continued reduction in antibiotic use is an encouraging sign that the importance of antibiotics is now recognised by prescribers and patients alike.

Having said that, antibiotic use in acute hospitals continued to increase in 2017. Antibiotics are vital for people in hospitals with serious infections. The way antibiotics should be used in hospitals is a balance between obtaining the best clinical outcome for the individual and minimising harm to them and the population through the development of resistance.

Dr Andrew Seaton, Chair of the Scottish Antimicrobial Prescribing Group said: "It is vital that action to improve antibiotic use is increased. Healthcare workers and the public need to understand and value the importance of this precious resource."

Antibiotic resistance in human infections

The report also outlines that resistance to antibiotics in the common organisms that cause the majority of infections has remained stable.

Professor Alistair Leanord, Director of Scottish Microbiology Reference Laboratories, said: "It is re-assuring that we have not seen any significant changes in resistance to antibiotics in the common organisms that cause the majority of infections. However, the burden of disease caused by drug resistant infections was recently confirmed in a European study which estimated that approximately 33,000 people die each year as a direct consequence of an infection caused by antibiotic resistant bacteria."

Professor Jacqui Reilly, Lead Consultant for Healthcare Associated Infections (HAI), Antimicrobial Resistance (AMR) and Infection Prevention and Control (IPC) at Health Protection Scotland added:

"An effective way to preserve the effectiveness of antibiotics is to prevent infections and avoid the need to use antibiotics. Health Protection Scotland continues to work with a range of organisations to prevent infections, not only in hospitals and care homes but, increasingly, within the wider population in the community."

Animal resistant infections

While AMR in animals is generally stable, the report reiterates the importance of human and animal health professionals and the public continuing to work together to preserve the effectiveness of antimicrobials for the future.

Professor Dominic Mellor, Consultant Veterinary Public Health, Health Protection Scotland, explained: "It is essential in the coming years to continue to add both depth and breadth to the intelligence that forms the basis of the report, so as to appreciate more clearly the causation of AMR, and to design more precise and effective interventions to mitigate its threat."

The public has an important role to play in keeping antibiotics working by following the advice of their professional such as doctors, nurses, dentists, pharmacists and vets, regarding the need for antibiotics.




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Health Protection Scotland
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Notes to the Editor

  • The Scottish One Health Antimicrobial Use and Antimicrobial Resistance Report 2017 is available here:
  • The Scottish One Health Antimicrobial Use and Antimicrobial Resistance Report (SONAAR) Report is intended to support NHS boards, hospitals and primary care in their long-term planning of antimicrobial prescribing. In particular, this report should be of use to Antimicrobial Management Teams (AMTs), Infection prevention and Control Teams (ICTs) and Microbiologists.
  • Scottish Antimicrobial Prescribing Group (SAPG) guidance on prescribing is available at:
  • Health Protection Scotland (HPS) is part of NHS National Services Scotland (NSS), providing services critical to frontline patient care and supportive of the efficient and effective operation of NHSScotland.
  • This week marks World Antibiotic Awareness Week
  • There has been a 7.8% decrease in antibiotic use in primary care between 2013 and 2017.
  • Antibiotic use in acute hospitals was 18% higher in 2017 than in 2013.



What are antimicrobials?
Antimicrobials is a term used to describe antibiotics and other medicines.

What is antimicrobial resistance?
Antibiotic resistance arises when bacteria evolve and develop traits which enable them to survive exposure to medicines that would normally kill them.

Why is antimicrobial resistance a problem?
Without effective antibiotics, serious infections cannot be treated. It is essential to preserve our remaining antibiotics.

What are carbapenems?
Carbapenems are a group of powerful antimicrobials which are used to treat a number of serious or antibiotic resistant infections.

What is meant by overuse and inappropriate use of antibiotics?
Inappropriate use might involve prescription of antibiotics unsuitable for the infection (including viral infections, such as the common cold, which are not cured by antibiotic treatment), or it may be that a patient does not finish their course of antibiotics, meaning that the bacteria are not all killed.