| Summary: | Streptococcus pneumoniae is the leading cause of infectious childhood conditions such as Otitis Media (OM) and Pneumonia. Amoxicillin is the recommended first-line treatment for these indications. But because of growing resistance to penicillin based and other antibiotics prevention via effective immunisation is a more desirable approach. PCV7 was introduced in the UK in 2006. Studies conducted in the USA and Europe have shown that the use of this vaccine successfully reduces the incidence of OM and pneumonia. Yet its impact on community antibiotic use in the UK has not to date been adequately described. This thesis presents the findings of two retrospective cohort studies that analysed the diagnosed incidence of OM and pneumonia and the associated antibiotic prescribing, using the IMS DA and THIN GP databases. The extensive data manipulation conducted shows that the overall number of (all cause) pneumonia episodes in children recorded by GPs declined by 14% between 2006 and 2010. Associated antibiotic prescribing fell by 10%. In addition, the research presented here identified a fall of more than a third in primary care recorded OM diagnoses and antibiotic prescribing for the treatment of OM in children between 2006 and 2010. These data represent new evidence that the introduction of the original conjugated PCV7 contributed to a decline in antibiotic prescribing by GPs. However, additional prescribing behaviour change drivers were involved and consumption by patients may have fallen faster than the available data sets suggest. The PCV7 has now been replaced by the PCV13. Against this background a range of additional policy questions are discussed. They include issues relating to bacterial serotype replacement trends and virulence shifts, and the implications of effective infant and child protection for the health of older adults at high risk of contracting pneumococcal infections.
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