Antibiotics and asthma medication for acute LRTI in people with and without asthma

  • Denholm R & al.
  • Respir Res
  • 6 Jan 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • This study found high-use of antibiotics and asthma medications for the treatment of acute lower respiratory tract infections (ALRTIs) in patients with and without asthma, respectively, with considerable between-practice variation.

Why this matters

  • Despite limited evidence of benefits and in contradiction to national guidelines, general practices are continuing to frequently prescribe antibiotics for ALRTIs.

Study design

  • This retrospective cohort study included 110,418 patients with (n=17,952) or without (n=92,466) using data from the Clinical Practice Research Datalink (CPRD).
  • Funding: NIHR Research Professorship.

Key results

  • Overall, 127,976 incidences of ALRTIs were reported; 81.1% and 79.4% of patients with and without asthma received antibiotics and 41.1% and 14.7% asthma medication.
  • There were significant differences in between-practice prescribed for all treatments, with greatest differences observed for:
    • oral steroids:
      • with (OR, 17.76; 95% CI, 6.55-81.91) and without (OR, 93.92; 95% CI, 33.15-362.72) asthma.
    • asthma medication only:
      • with (OR, 7.46; 95% CI, 4.00-18.46) and without (OR, 17.18; 95% CI, 10.08-33.1) asthma.
  • In patients with asthma, independent predictors of antibiotic prescription included:
    • fewer previous ALRTI episodes (OR, 0.25; 95% CI, 0.17-0.39);
    • higher practice (OR, 1.47; 95% CI, 1.35-1.59);
    • prior antibiotic prescription (OR, 1.28; 95% CI, 1.04-1.57); and
    • concurrent asthma medication (OR, 1.44; 95% CI, 1.32-1.57; P<.001 for all>
  • Higher previous asthma medication prescription (OR, 2.31; 95% CI, 1.83-2.91) and concurrent antibiotic prescription (OR, 3.59; 95% CI, 3.22-4.01; P<.001 for both were independent predictor of asthma medication in patients without asthma.>

Limitations

  • Retrospective design.