Impact of Rotavirus Vaccination on Antibiotic Prescribing in Primary Care: A UK retrospective cohort study

Background: Rotavirus vaccination programmes for infants have significantly reduced the incidence of rotavirus gastroenteritis. Vaccines which decrease disease incidence can reduce antibiotic prescribing and may help combat antimicrobial resistance. A US cohort study found a significant association between rotavirus vaccination and reduced antibiotic prescribing. However, no studies have investigated this association in the UK, where infant rotavirus vaccination was introduced in 2013. Methods: We conducted a retrospective cohort study using the Clinical Practice Research Datalink Aurum, a large representative dataset of UK primary care health records. Between 2010 and 2020, children were assessed for rotavirus vaccination status and followed from six months to seven years of age. The outcome was an antibiotic prescription within seven days following an all-cause acute gastroenteritis (AGE) diagnosis. Recurrent time-to-event modelling was used to estimate adjusted hazard ratios (aHR) accounting for sex, deprivation, urban-rural status, seasonality and health-seeking behaviour. Model estimates were used to predict the prescribing events averted by rotavirus vaccination. Results: Of 429,009 participants eligible for inclusion, 2.4% (10,328 participants) experienced an AGE-linked antibiotic prescribing event. For participants who received one or more rotavirus vaccines, after adjusting for covariates, the aHR was 0.74 (95% CI 0.71–0.77). This finding was robust across several sensitivity analyses, including changing the outcome definition to an antibiotic prescription within 3 days of an acute gastroenteritis diagnosis aHR 0.74 (95% CI 0.71–0.77). We also estimated that in a UK birth cohort born between 2014 and 2019 rotavirus vaccination has averted 12,635 (95%CI 11,363 − 14,109) AGE-linked prescriptions. Conclusions: Rotavirus vaccination was associated with a significantly lower rate of antibiotic prescribing in UK primary care. This is the first UK study to investigate this association, and our findings are consistent with the US cohort study and studies in low and middle-income countries. Our study provides further evidence that rotavirus vaccines are effective against disease in primary care and may contribute to antimicrobial stewardship.