King's College London

Research portal

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

Research output: Contribution to journalArticle

Standard

Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care : cohort study using electronic health records. / Gulliford, Martin C; Moore, Michael V; Little, Paul; Hay, Alastair D; Fox, Robin; Prevost, A Toby; Juszczyk, Dorota; Charlton, Judith; Ashworth, Mark.

In: BMJ (Clinical research ed.), Vol. 354, i3410, 2016.

Research output: Contribution to journalArticle

Harvard

Gulliford, MC, Moore, MV, Little, P, Hay, AD, Fox, R, Prevost, AT, Juszczyk, D, Charlton, J & Ashworth, M 2016, 'Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records', BMJ (Clinical research ed.), vol. 354, i3410. https://doi.org/10.1136/bmj.i3410

APA

Gulliford, M. C., Moore, M. V., Little, P., Hay, A. D., Fox, R., Prevost, A. T., ... Ashworth, M. (2016). Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records. BMJ (Clinical research ed.), 354, [i3410]. https://doi.org/10.1136/bmj.i3410

Vancouver

Gulliford MC, Moore MV, Little P, Hay AD, Fox R, Prevost AT et al. Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records. BMJ (Clinical research ed.). 2016;354. i3410. https://doi.org/10.1136/bmj.i3410

Author

Gulliford, Martin C ; Moore, Michael V ; Little, Paul ; Hay, Alastair D ; Fox, Robin ; Prevost, A Toby ; Juszczyk, Dorota ; Charlton, Judith ; Ashworth, Mark. / Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care : cohort study using electronic health records. In: BMJ (Clinical research ed.). 2016 ; Vol. 354.

Bibtex Download

@article{5423ef8d391649c0a502aaa10fdccae8,
title = "Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records",
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.",
author = "Gulliford, {Martin C} and Moore, {Michael V} and Paul Little and Hay, {Alastair D} and Robin Fox and Prevost, {A Toby} and Dorota Juszczyk and Judith Charlton and Mark Ashworth",
note = "Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.",
year = "2016",
doi = "10.1136/bmj.i3410",
language = "English",
volume = "354",
journal = "BMJ (Clinical research ed.)",
issn = "1756-1833",
publisher = "BMJ Publishing Group",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care

T2 - cohort study using electronic health records

AU - Gulliford, Martin C

AU - Moore, Michael V

AU - Little, Paul

AU - Hay, Alastair D

AU - Fox, Robin

AU - Prevost, A Toby

AU - Juszczyk, Dorota

AU - Charlton, Judith

AU - Ashworth, Mark

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PY - 2016

Y1 - 2016

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84978237173&partnerID=8YFLogxK

U2 - 10.1136/bmj.i3410

DO - 10.1136/bmj.i3410

M3 - Article

C2 - 27378578

VL - 354

JO - BMJ (Clinical research ed.)

JF - BMJ (Clinical research ed.)

SN - 1756-1833

M1 - i3410

ER -

View graph of relations

© 2018 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454