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Study urges antibiotics for chest infections in over-65s

GPs should prescribe antibiotics to patients over 65 with lower respiratory tract infections to prevent them developing pneumonia, a new study concludes.

The recommendation, at odds with current guidance, came after the researchers directly linked cuts in antibiotic use with a raised risk of pneumonia, Emma Wilkinson writes.

Epidemiological research has linked cuts in antibiotic use to rises in hospitalisations for respiratory tract infections on a population level, but the new study looked at prescribing in individual patients.

Antibiotic use for lower respiratory tract infection cut the risk of pneumonia in patients of all ages by 66 per cent. The number needed to treat to prevent a case of pneumonia was as low as 47 for patients aged over 65.

Study leader Dr Andrew Hayward, senior lecturer in infectious disease epidemiology at University College London, told Pulse: 'I think the figures certainly justify prescribing in that age group.'

Antibiotic use in patients with upper respiratory tract infections also cut the risk of pneumonia, by up to 37 per cent among the over-65s. But Dr Hayward said it was not worth treating these groups. 'For upper respiratory tract infection you have to treat an awful lot of people to prevent an adverse event,' he said.

Dr Hayward is presenting the study, of data from 162 practices over a 10-year period, at the Health Protection Agency annual conference in September. He also hopes to present the results of additional analysis, to determine whether factors such as smoking and chronic illness can further predict who should be prescribed antibiotics.

Dr Sonia Saxena, lecturer in primary care at Imperial College London and one of the researchers to have previously linked cuts in antibiotic use with hospitalisations, warned the new data suggested the drive for a blanket reduction in prescribing was inappropriate.

Dr Saxena, a GP in Putney, south-west London, said: 'In primary care we have varied patient populations and it shows antibiotics are effective for respiratory illness in certain age groups – it's not simply about reducing antibiotics.'

Dr Michael Moore, senior lecturer in primary medical care at the University of Southampton, suggested GPs should use delayed prescribing after his own research found it effective at preventing re-attendance.

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