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Curb on antibiotics may fuel respiratory admission rise

Reductions in antibiotic prescribing may be fuelling an increase in hospital admissions for respiratory infections, researchers from the UK and US conclude.

Their study, published online by the Journal of the Royal Society of Medicine, warned cutting antibiotic scripts might have 'unintended consequences', writes Danusia Osiowy.

The researchers suggested some patients with early pneumonia might be missing out on treatment because GPs were misdiagnosing them with acute bronchitis – and were no longer prescribing these patients anti-biotics.

In three of seven time periods examined, ambulatory antibiotic prescriptions were negatively correlated with hospital admissions, the study of US

data found.

Over the period examined, from 1996 to 2003, the proportion of total hospitalisations that were for pneumonia increased from 3.25 per cent to 3.69 per cent. The proportion that were for chronic bronchitis and emphysema also increased, from 1.75 to 1.84 per cent.

Dr Sonia Saxena, a research-er on the study and clinical lecturer in primary care at Imperial College London, said: 'The overwhelming message in the past has been not to issue anti-biotics as most respiratory infections are viral. But GPs need to think twice about a blanket reduction in antibiotics for all respiratory infections.'

The researchers advised GPs to rule out serious lower respiratory infections before diagnosing acute bronchitis.

Professor Paul Little, professor of primary care research at the University of Southampton, said GPs lacked the data to reduce antibiotic use. 'How can we reduce prescriptions when we don't know which groups to cut down? Until we do, we should aim to prescribe judiciously,' he said.

Professor Peter Davey, a member of the Standing Advisory Committee on Antimicrobial Resistance and consultant in infectious diseases at Ninewells Hospital in Dundee, said: 'There is room for improvement between GPs and hospitals on respiratory infections, particularly as GPs can't make a diagnosis of pneumonia until a chest X-ray is completed.'

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