Within-episode repeat antibiotic prescriptions in patients with respiratory tract infections: A population-based cohort study - 30/03/24
, Roderick P. Venekamp c, Albert Bolhuis d, Patrick C. Souverein b, Janneke H.H.M. van de Wijgert c, Martin C. Gulliford e, Alastair D. Hay fSummary |
Background |
Antimicrobial stewardship interventions mainly focus on initial antibiotic prescriptions, with few considering within-episode repeat prescriptions. We aimed to describe the magnitude, type and determinants of within-episode repeat antibiotic prescriptions in patients presenting to primary care with respiratory tract infections (RTIs).
Methods |
We conducted a population-based cohort study among 530 sampled English general practices within the Clinical Practice Research Datalink (CPRD). All individuals with a primary care RTI consultation for which an antibiotic was prescribed between March 2018 and February 2022. Main outcome measurement was repeat antibiotic prescriptions within 28 days of a RTI visit stratified by age (children vs. adults) and RTI type (lower vs. upper RTI). Multivariable logistic regression and principal components analyses were used to identify risk factors and patient clusters at risk for within-episode repeat prescriptions.
Findings |
905,964 RTI episodes with at least one antibiotic prescription were identified. In adults, 19.9% (95% CI 19.3–20.5%) had at least one within-episode repeat prescription for a lower RTI, compared to 10.5% (95% CI 10.3–10.8%) for an upper RTI. In children, this was around 10% irrespective of RTI type. The majority of repeat prescriptions occurred a median of 10 days after the initial prescription and was the same antibiotic class in 48.3% of cases. Frequent RTI related GP visits and prior within-RTI-episode repeat antibiotic prescriptions were main factors associated with repeat prescriptions in both adults and children irrespective of RTI type. Young (<2 years) and older (65+) age were associated with repeat prescriptions. Among those aged 2–64 years, allergic rhinitis, COPD and oral corticosteroids were associated with repeat prescriptions.
Interpretations |
Repeat within-episode antibiotic use accounts for a significant proportion of all antibiotics prescribed for RTIs, with same class antibiotics unlikely to confer clinical benefit and is therefore a prime target for future antimicrobial stewardship interventions.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Within-episode repeat antibiotic prescription is common with an overall proportion of 13%. |
• | Repeats typically occur 10 days after the initial prescription, with the same antibiotic class used in nearly half. |
• | Consultation behaviour and prior antibiotic repeats were the main factors associated with repeat antibiotic prescriptions. |
• | Reducing within-episode antibiotic prescriptions could represent a "quick win" for antimicrobial stewardship teams. |
Keywords : Primary care, Antibiotic stewardship, General practice, Respiratory tract infections, Antibiotic prescribing, Observational study, Epidemiology
Plan
| This study was approved by CPRD’s Research Data Governance (RDG) Process (protocol 22_001775). |
Vol 88 - N° 4
Article 106135- avril 2024 Retour au numéro
Article précédent
- Ivermectin for COVID-19 in adults in the community (PRINCIPLE): An open, randomised, controlled, adaptive platform trial of short- and longer-term outcomes
- Gail Hayward, Ly-Mee Yu, Paul Little, Oghenekome Gbinigie, Milensu Shanyinde, Victoria Harris, Jienchi Dorward, Benjamin R. Saville, Nicholas Berry, Philip H. Evans, Nicholas P.B. Thomas, Mahendra G. Patel, Duncan Richards, Oliver V. Hecke, Michelle A. Detry, Christina Saunders, Mark Fitzgerald, Jared Robinson, Charlotte Latimer-Bell, Julie Allen, Emma Ogburn, Jenna Grabey, Simon de Lusignan, FD Richard Hobbs, Christopher C. Butler, PRINCIPLE Trial Collaborative Group
- AZD1222 effectiveness against severe COVID-19 in individuals with comorbidity or frailty: The RAVEN cohort study
- Wilhelmine Meeraus, Mark Joy, Mario Ouwens, Kathryn S. Taylor, Sudhir Venkatesan, John Dennis, Trung N. Tran, Ashkan Dashtban, Xuejuan Fan, Robert Williams, Tamsin Morris, Lucy Carty, Debasish Kar, Uy Hoang, Michael Feher, Anna Forbes, Gavin Jamie, William Hinton, Kornelia Sanecka, Rachel Byford, Sneha N. Anand, F.D. Richard Hobbs, David A. Clifton, Andrew J. Pollard, Sylvia Taylor, Simon de Lusignan
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?