Two new UK studies on antibiotic prescribing in primary care make important contributions to the growing evidence base informing policy on antimicrobial stewardship, according to an editorial in the BMJ.
The first study evaluated the association between antibiotic treatment for urinary tract infection (UTI) and severe adverse outcomes in 157,264 adults aged 65 years or older presenting to a general practitioner with at least one diagnosis of suspected or confirmed lower UTI from November 2007 to May 2015.
No antibiotics and deferred antibiotics were associated with a significant increase in bloodstream infection and all-cause mortality compared with immediate antibiotics. In the context of an increase of Escherichia coli bloodstream infections in England, early initiation of recommended first-line antibiotics for UTI in the older population was advocated.
The second study examined almost one million general practice consultations between 2013-2015 that resulted in an antibiotic prescription across 13 indications. The most common reasons for antibiotics being prescribed were acute cough and bronchitis (386,972, 41.6% of the included consultations), acute sore throat (239,231, 25.7%), acute otitis media (83,054, 8.9%), and acute sinusitis (76,683, 8.2%).
This study found that for most common infections treated in primary care, a substantial proportion of antibiotic prescriptions have durations exceeding those recommended in national guidelines. Substantial reductions in antibiotic exposure can be accomplished by aligning antibiotic prescription durations with guidelines, the authors concluded.
The BMJ editorial states that both studies highlight the daily challenge of ensuring that patients who are unlikely to benefit from antibiotics are not treated, whereas those who require them receive the right class, at the right time, at the right dose, and for the right duration.