Antibiotic prescribing and use in United Kingdom general practices in socio-economically deprived areas: a critical interpretive synthesis

General Practice is where most antibiotics are prescribed, yet a concerning trend has been observed – higher prescribing/use of antibiotics in socio-economically deprived settings. We aimed to critically interrogate the literature by exploring if prescribing/use of antibiotics throughout United Kingdom general practices is associated with deprivation, and if so, how. Five databases (CINAHL, Embase, Medline, Science Citation Index/Social Science Citation Index and Scopus) were searched. From 1464 gathered papers, 23 were included. 21 identified an association between deprivation and antibiotic prescribing/use and two papers found no association. From the 21, 15 utilized prescribing data, with 12 of these showing that as deprivation increased, so did prescribing, and three papers finding the opposite trend. Of the remaining 6 papers, four studies utilizing self-reported data identified a perceived risk of increased prescribing among socioeconomically deprived patients and two papers identified mixed results. Author interpretations of the relationship between antibiotic prescribing/use and deprivation considered overlapping clinical and social factors, which we then used to support our final synthesizing argument – observed prescribing variation is linked to inequalities and could be conceptualized as a form of “structural violence.” Research is needed to establish how structural inequalities shape the prescribing/use dynamic within these vulnerable communities.