30 Chapter 2 Conclusions We found substantial variation in both the volume of antibiotic prescriptions in primary care and the prevalence of SDRMs between countries. There is, however, a clear association between the volume of antibiotic prescribing and the prevalence of SDRMs. Approximately 90% of the ASP expressed in the ASI originated from primary care, which is even more associated with the prevalence of SDRMs, compared with the volume of antibiotic prescribing. This emphasizes that the role of primary care in the development of AMR may be much larger than previously assumed by some GPs. This is an important insight, because some GPs may believe that antibiotic prescribing in their practice does not contribute to the development of AMR, but that instead AMR is driven by antibiotic prescriptions in hospitals or those used in veterinary care. The societal and medical impacts of this phenomenon warrant further investigation into mechanisms for improvement and implementation of antibiotic stewardship in primary care.
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