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Significant proportion of RTIs given more than one antibiotic course

Significant proportion of RTIs given more than one antibiotic course

Almost one in five adults and one in ten children receive a second course of antibiotics for the same respiratory tract infection, researchers have found.

Analysis of GP records of more than 900,000 cases of respiratory tract infection across 530 practices in England also found that in half the cases of repeat antibiotic prescribing, the same antibiotic class was used.

Writing in the Journal of Infection, the researchers said reducing ‘within-episode’ repeat antibiotic prescribing could be a ‘quick win’ for improving antibiotic stewardship.

Among the cases looked at, which all had at least one antibiotic prescribed, 19.9% of adults with a lower respiratory tract infection had at least one other antibiotic prescription within 28 days as did 10.5% for an upper respiratory tract infection.

In children, the researchers found a repeat antibiotic prescribing rate of around 10% regardless of the type of respiratory tract infection.

Most repeat prescriptions occurred around 10 days after the initial antibiotic was given and 48.3% were the from the same antibiotic class, the researchers found.

Among the factors associated with repeat prescribing for the same illness, were frequent visits to the GP for respiratory tract infections and previous within-episode antibiotic prescribing for the condition.

Children under the age of two years and adults over 65 years were also more likely to have repeat antibiotics for the same episode, the researchers found.

Primary care guidelines recommend a no or delayed antibiotic prescribing strategy in the vast majority of patients with respiratory tract infection, yet 54% of consultations in the UK lead to an antibiotic prescription, the researchers said.

Respiratory tract infections also account for 60% of antibiotic prescribing in primary care globally and have been identified as one of the key drivers of antimicrobial resistance, they added.

This is despite previous research showing that for most child and adult patients with chest infections, particularly those without chronic lung disease, even a single antibiotic course is unlikely to have clinical benefit, they noted.

Study author Professor Alastair Hay, a GP and professor of primary care at the University of Bristol, said: ‘It seems implausible that repeat antibiotic courses will have any benefit given that there is clear evidence that children and adults without chronic lung disease do not benefit from a first course of antibiotics, and that NICE recommends five-day antibiotic courses for the severest lower respiratory tract infections, such as pneumonia.’

Co-author Arief Lalmohamed, senior lecturer at University Medical Center, Utrecht, said their research showed repeat within-episode antibiotic use accounts for a ‘significant proportion’ of all antibiotics prescribed for respiratory tract infections.

‘In light of our findings, it’s clear that antimicrobial stewardship interventions must extend beyond initial antibiotic prescriptions to address within-episode repeats.’


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David Church 16 April, 2024 1:22 pm

Is this becasue one ‘course’ of antibiotics used to last 7 -10 days, but now every 3 days of antibiotics counts as one whole course?
Some countries use bigger doses, for longer, then we do here.
And lots of patients are told by specialists that they must take a course of antibiotics as soon as possible every time they feel a cold coming on.

Mo Anon 16 April, 2024 1:51 pm

I tend to find our ANP colleagues at the practice and OOH, will give abx within a week or a few days of coryzal type symptoms. There is no recourse but after the third course will usually be booked in to the GP –

Mark Howson 16 April, 2024 3:32 pm

Patients will think the infection persists because the cough persists and I will advise that the bacteria have been killed but the damage they did needs time to heal before the cough settles and this can take up to 4 weeks. And the ones where the cough
settles quickly were never a LRTI infection anyway.

David Taylor 16 April, 2024 3:34 pm

Patients are just less willing to accept having coryzal symptoms and so call more and more quickly which increases demand to unsustainable levels therefore easier to prescribe even if not required. Then because they have called on day 3-5 rather than day 7-10 the viral type symptoms haven’t eased at the end of the course so they call again. I think this has been exacerbated by some confusing and overly cautious Public Health messaging which has essentially got everyone going to drs much sooner than before (guidance used to be 6 weeks cough for CXR now 3 weeks!), not to mention the health anxiety brought on by COVID.
So in short we have more patients calling sooner, less willing to allow things to settles resulting in overwhelmed primary care services giving out prescriptions more quickly – a vicious cycle which I fear is hard to get out of.

Turn out The Lights 16 April, 2024 9:10 pm

Antibiotic oblivion here we come.