Duration of antibiotic treatment for common infections in English primary care: cross sectional analysis and comparison with guidelines.

Authors:
Koen B Pouwels
Koen B Pouwels
University of Groningen
Netherlands
Susan Hopkins
Susan Hopkins
University of California
United States
Martin J Llewelyn
Martin J Llewelyn
Brighton and Sussex University Hospitals NHS Trust
Ann Sarah Walker
Ann Sarah Walker
University of Oxford
Oxford | United States
Cliodna Am McNulty
Cliodna Am McNulty
Gloucestershire Royal Hospital
United Kingdom
Julie V Robotham
Julie V Robotham
University of Nottingham
United Kingdom

BMJ 2019 02 27;364:l440. Epub 2019 Feb 27.

Modelling and Economics Unit, National Infection Service, Public Health England, London NW9 5EQ, UK.

Objective: To evaluate the duration of prescriptions for antibiotic treatment for common infections in English primary care and to compare this with guideline recommendations.

Design: Cross sectional study.

Setting: General practices contributing to The Health Improvement Network database, 2013-15.

Participants: 931 015 consultations that resulted in an antibiotic prescription for one of several indications: acute sinusitis, acute sore throat, acute cough and bronchitis, pneumonia, acute exacerbation of chronic obstructive pulmonary disease (COPD), acute otitis media, acute cystitis, acute prostatitis, pyelonephritis, cellulitis, impetigo, scarlet fever, and gastroenteritis.

Main Outcome Measures: The main outcomes were the percentage of antibiotic prescriptions with a duration exceeding the guideline recommendation and the total number of days beyond the recommended duration for each indication.

Results: The most common reasons for antibiotics being prescribed were acute cough and bronchitis (386 972, 41.6% of the included consultations), acute sore throat (239 231, 25.7%), acute otitis media (83 054, 8.9%), and acute sinusitis (76 683, 8.2%). Antibiotic treatments for upper respiratory tract indications and acute cough and bronchitis accounted for more than two thirds of the total prescriptions considered, and 80% or more of these treatment courses exceeded guideline recommendations. Notable exceptions were acute sinusitis, where only 9.6% (95% confidence interval 9.4% to 9.9%) of prescriptions exceeded seven days and acute sore throat where only 2.1% (2.0% to 2.1%) exceeded 10 days (recent guidance recommends five days). More than half of the antibiotic prescriptions were for longer than guidelines recommend for acute cystitis among females (54.6%, 54.1% to 55.0%). The percentage of antibiotic prescriptions exceeding the recommended duration was lower for most non-respiratory infections. For the 931 015 included consultations resulting in antibiotic prescriptions, about 1.3 million days were beyond the durations recommended by guidelines.

Conclusion: For most common infections treated in primary care, a substantial proportion of antibiotic prescriptions have durations exceeding those recommended in guidelines. Substantial reductions in antibiotic exposure can be accomplished by aligning antibiotic prescription durations with guidelines.

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Source
http://dx.doi.org/10.1136/bmj.l440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6391655PMC
February 2019
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