18
IRUS Total
Downloads

Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records

File Description SizeFormat 
bmj.i3410.full.pdfPublished version541.56 kBAdobe PDFView/Open
Title: Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records
Authors: Gulliford, MC
Moore, MV
Little, P
Hay, AD
Fox, R
Prevost, AT
Juszczyk, D
Charlton, J
Ashworth, M
Item Type: Journal Article
Abstract: Objective To determine whether the incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre’s syndrome is higher in general practices that prescribe fewer antibiotics for self limiting respiratory tract infections (RTIs). Design Cohort study. Setting 610 UK general practices from the UK Clinical Practice Research Datalink. Participants Registered patients with 45.5 million person years of follow-up from 2005 to 2014. Exposures Standardised proportion of RTI consultations with antibiotics prescribed for each general practice, and rate of antibiotic prescriptions for RTIs per 1000 registered patients. Main outcome measures Incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre’s syndrome, adjusting for age group, sex, region, deprivation fifth, RTI consultation rate, and general practice. Results From 2005 to 2014 the proportion of RTI consultations with antibiotics prescribed decreased from 53.9% to 50.5% in men and from 54.5% to 51.5% in women. From 2005 to 2014, new episodes of meningitis, mastoiditis, and peritonsillar abscess decreased annually by 5.3%, 4.6%, and 1.0%, respectively, whereas new episodes of pneumonia increased by 0.4%. Age and sex standardised incidences for pneumonia and peritonsillar abscess were higher for practices in the lowest fourth of antibiotic prescribing compared with the highest fourth. The adjusted relative risk increases for a 10% reduction in antibiotic prescribing were 12.8% (95% confidence interval 7.8% to 17.5%, P<0.001) for pneumonia and 9.9% (5.6% to 14.0%, P<0.001) for peritonsillar abscess. If a general practice with an average list size of 7000 patients reduces the proportion of RTI consultations with antibiotics prescribed by 10%, then it might observe 1.1 (95% confidence interval 0.6 to 1.5) more cases of pneumonia each year and 0.9 (0.5 to 1.3) more cases of peritonsillar abscess each decade. Mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre’s syndrome were similar in frequency at low prescribing and high prescribing practices. Conclusions General practices that adopt a policy to reduce antibiotic prescribing for RTIs might expect a slight increase in the incidence of treatable pneumonia and peritonsillar abscess. No increase is likely in mastoiditis, empyema, bacterial meningitis, intracranial abscess, or Lemierre’s syndrome. Even a substantial reduction in antibiotic prescribing was predicted to be associated with only a small increase in numbers of cases observed overall, but caution might be required in subgroups at higher risk of pneumonia.
Issue Date: 4-Jul-2016
Date of Acceptance: 7-Jun-2016
URI: http://hdl.handle.net/10044/1/71337
DOI: https://dx.doi.org/10.1136/bmj.i3410
ISSN: 0959-8138
Publisher: BMJ Publishing Group
Journal / Book Title: BMJ: British Medical Journal
Volume: 354
Copyright Statement: © BMJ Publishing Group Ltd 2016. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 3.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/3.0/.
Sponsor/Funder: NIHR Health Technology Assessment
Funder's Grant Number: 13/88/10
Keywords: Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
CLUSTER RANDOMIZED-TRIAL
SORE THROAT
COMPLICATIONS
STRATEGIES
PNEUMONIA
ILLNESS
RATES
Anti-Bacterial Agents
Cohort Studies
Electronic Health Records
Empyema
Female
General Practice
Humans
Inappropriate Prescribing
Incidence
Lemierre Syndrome
Male
Mastoiditis
Meningitis
Patient Safety
Peritonsillar Abscess
Pneumonia
Practice Patterns, Physicians'
Respiratory Tract Infections
United Kingdom
Humans
Respiratory Tract Infections
Peritonsillar Abscess
Empyema
Pneumonia
Mastoiditis
Meningitis
Anti-Bacterial Agents
Incidence
Cohort Studies
Female
Male
Electronic Health Records
Lemierre Syndrome
Inappropriate Prescribing
General Practice
Patient Safety
Practice Patterns, Physicians'
United Kingdom
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
PRACTICE RESEARCH DATABASE
CLUSTER RANDOMIZED-TRIAL
SORE THROAT
UK
COMPLICATIONS
STRATEGIES
PNEUMONIA
ENGLAND
ILLNESS
RATES
Publication Status: Published
Open Access location: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4933936/
Article Number: ARTN i3410
Online Publication Date: 2016-07-04
Appears in Collections:School of Public Health