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OBJECTIVES: To explore the causes of the gender gap in antibiotic prescribing, and to determine whether women are more likely than men to receive an antibiotic prescription per consultation. DESIGN: Cross-sectional analysis of routinely collected electronic medical records from The Health Improvement Network (THIN). SETTING: English primary care. PARTICIPANTS: Patients who consulted general practices registered with THIN between 2013 and 2015. PRIMARY AND SECONDARY OUTCOME MEASURES: Total antibiotic prescribing was measured in children (<19 years), adults (19-64 years) and the elderly (65+ years). For 12 common conditions, the number of adult consultations was measured, and the relative risk (RR) of being prescribed antibiotics when consulting as female or with comorbidity was estimated. RESULTS: Among 4.57 million antibiotic prescriptions observed in the data, female patients received 67% more prescriptions than male patients, and 43% more when excluding antibiotics used to treat urinary tract infection (UTI). These gaps were more pronounced in adult women (99% more prescriptions than men; 69% more when excluding UTI) than in children (9%; 0%) or the elderly (67%; 38%). Among adults, women accounted for 64% of consultations (62% among patients with comorbidity), but were not substantially more likely than men to receive an antibiotic prescription when consulting with common conditions such as cough (RR 1.01; 95% CI 1.00 to 1.02), sore throat (RR 1.01, 95% CI 1.00 to 1.01) and lower respiratory tract infection (RR 1.00, 95% CI 1.00 to 1.01). Exceptions were skin conditions: women were less likely to be prescribed antibiotics when consulting with acne (RR 0.67, 95% CI 0.66 to 0.69) or impetigo (RR 0.85, 95% CI 0.81 to 0.88). CONCLUSIONS: The gender gap in antibiotic prescribing can largely be explained by consultation behaviour. Although in most cases adult men and women are equally likely to be prescribed an antibiotic when consulting primary care, it is unclear whether or not they are equally indicated for antibiotic therapy.

Original publication




Journal article


BMJ Open

Publication Date





antibacterial agents, antibiotic prescribing, consultation, electronic health records, gender bias, prescriptions, Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Anti-Bacterial Agents, Child, Child, Preschool, Comorbidity, Cross-Sectional Studies, Drug Prescriptions, Electronic Health Records, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Pharyngitis, Practice Patterns, Physicians', Primary Health Care, Referral and Consultation, Respiratory Tract Infections, Sex Distribution, United Kingdom, Urinary Tract Infections, Young Adult