Duration of antibiotic treatment for common infections in English primary care: cross sectional analysis and comparison with guidelines

Abstract

ObjectiveTo evaluate the duration of prescriptions for antibiotic treatment for common infections in English primary care and to compare this with guideline recommendations.DesignCross sectional study.SettingGeneral practices contributing to The Health Improvement Network database, 2013-15.Participants931 015 consultations that resulted in an antibiotic prescription for one of several indications: acute sinusitis, acute sore throat, acute cough and bronchitis, pneumonia, acute exacerbation of chronic obstructive pulmonary disease (COPD), acute otitis media, acute cystitis, acute prostatitis, pyelonephritis, cellulitis, impetigo, scarlet fever, and gastroenteritis.Main outcome measuresThe main outcomes were the percentage of antibiotic prescriptions with a duration exceeding the guideline recommendation and the total number of days beyond the recommended duration for each indication.ResultsThe 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%). Antibiotic treatments for upper respiratory tract indications and acute cough and bronchitis accounted for more than two thirds of the total prescriptions considered, and 80% or more of these treatment courses exceeded guideline recommendations. Notable exceptions were acute sinusitis, where only 9.6% (95% confidence interval 9.4% to 9.9%) of prescriptions exceeded seven days and acute sore throat where only 2.1% (2.0% to 2.1%) exceeded 10 days (recent guidance recommends five days). More than half of the antibiotic prescriptions were for longer than guidelines recommend for acute cystitis among females (54.6%, 54.1% to 55.0%). The percentage of antibiotic prescriptions exceeding the recommended duration was lower for most non-respiratory infections. For the 931 015 included consultations resulting in antibiotic prescriptions, about 1.3 million days were beyond the durations recommended by guidelines.ConclusionFor most common infections treated in primary care, a substantial proportion of antibiotic prescriptions have durations exceeding those recommended in guidelines. Substantial reductions in antibiotic exposure can be accomplished by aligning antibiotic prescription durations with guidelines.

Clinical practice guidelines for acute otitis media in children: a systematic review and appraisal of European national guidelines

“…Emerging research has also demonstrated that longer antibiotic courses can lead to higher risks of resistance. Thus, providing clear guidance on appropriate antibiotic use in terms of the indications, choice and duration is considered important to help reduce antibiotic resistance 18…”

Antibiotic prescribing in primary care

“…The second of the studies, by Pouwels and colleagues (doi:10.1136/bmj.l440), builds on good evidence that “short” antibiotic courses are as effective as “long” courses for most infections treated in primary care 1112. The authors used data from 2013 to 2015 to show convincingly that adhering to the latest national guidance on length of treatment for common infections would result in 14 fewer days of antibiotic use for every 10 prescriptions issued, or to around 65 million fewer antibiotic days each year for the UK 12. This is double the number of antibiotic days that would be saved if the UK were to hit its 2016 target of halving unnecessary antibiotic prescriptions by 2020 (assuming a seven day current average course length) 13…”

Harnessing the wisdom of crowds can improve guideline compliance of antibiotic prescribers and support antimicrobial stewardship

“…Recent clinical trials, for example, have suggested that traditional courses of antibiotics could be shortened without compromising patient safety 37 , 38 , but this latest evidence has not yet been translated into guidelines. Hence, even though IDSA and SPILF guidelines are used widely internationally, their recommendations are by no means undisputed 39 , 40 . This also leaves prescribers more vulnerable to behavioural biases.…”