Antibiotic prescribing rates for respiratory tract infections in UK general practice vary widely by illness severity as well as individual practice and geographical location, finds a new observational study in the Journal of Antimicrobial Chemotherapy.
The researchers used three illness severity scores to carry out a secondary analysis of three large cohort studies (carried out between 2006-2013) on general practice respiratory patients prescribed antibiotics: the "FeverPAIN" score in an adult acute sore throat cohort (n=12,829), the "3C score" in an adult acute lower respiratory tract infection cohort (n=28,883), and the STARWAVe score in an acute cough and respiratory infection children’s cohort (n=8394).
They calculated median odds ratios (ORs) to quantify practice-level variation in prescribing rates, adjusted for illness severity.
The results showed substantial variability in practice prescribing rates (ranges of 0%-97%, 7%-100% and 0%-75% in the three cohorts, respectively).
There was evidence that higher prescribing practices saw a higher proportion of unwell patients. At the individual level, patients who were more unwell were more likely to receive a prescription, but prescribing levels for those with low scores were still high. The median OR was 2.5 (95% credible interval (CI)= 2.2-2.9) in the sore throat data set, 2.9 (95% CI=2.6-3.2) in the adult cough data set, and 2.1 (95% CI=1.8-2.4) in the children’s cough data set.
“Higher prescribing practices may see more unwell patients with high illness severity scores, but the differences in scores account for a minority of between-practice prescribing variation,” the study authors said. There is thus likely to be scope for further reductions in antibiotic prescribing among patients with low illness severity scores.
Further research is needed to explore the additional factors that account for variation in prescribing levels, the study concluded.