Antibiotic over-prescribing high in English primary care

  • Pouwels KB & al.
  • BMJ
  • 27 Feb 2019

  • curated by Dawn O'Shea
  • UK Medical News
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A substantial proportion of primary care antibiotic prescriptions for common infections exceed guideline-recommended treatment duration, according to a study published in the BMJ.

The cross-sectional study used data from The Health Improvement Network database 2013-2015 to identify 931,015 consultations that resulted in an antibiotic prescription for 1 of several indications: acute sinusitis, acute sore throat, acute cough and bronchitis, pneumonia, acute chronic obstructive pulmonary disease exacerbation, acute otitis media, acute cystitis, acute prostatitis, pyelonephritis, cellulitis, impetigo, scarlet fever and gastroenteritis.

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

The most common reasons for antibiotic prescriptions were acute cough and bronchitis (41.6% of consultations), acute sore throat (25.7%), acute otitis media (8.9%) and acute sinusitis (8.2%).

At least 80% of antibiotic treatment courses prescribed for upper respiratory tract infection and acute cough and bronchitis exceeded the duration of treatment recommended in guidelines. Notable exceptions were acute sinusitis, where only 9.6% of prescriptions exceeded 7 days and acute sore throat where only 2.1% exceeded 10 days.

The percentage of antibiotic prescriptions exceeding the recommended treatment duration was lower for most non-respiratory infections. For acute cystitis in females, 54.6% of antibiotic prescriptions were longer than the guidelines recommend.

If all patients had received treatment as per the guideline-recommended duration, the authors estimate that there would have been 1.1 million fewer days of antibiotics for respiratory tract indications and 100,000 fewer days for acute cystitis among females.

“Our findings indicate substantial scope for reducing antibiotic prescribing through better adherence to recommended durations of antibiotic treatment,” they say.