Use of antibiotics and asthma medication for acute lower respiratory tract infections in people with and without asthma: retrospective cohort study

Abstract

BackgroundAntibiotics are overused in patients with acute lower respiratory tract infections (ALRTIs), but less is known about their use in patients with asthma, or the use of asthma medication for ALRTI in patients without asthma. Our aim was to describe the frequency, variation and drivers in antibiotic and asthma medication prescribing for ALRTI in adults with and without asthma in primary care.MethodsA retrospective cohort analysis of patients aged ≥12 years, diagnosed with an ALRTI in primary care in 2014–15 was conducted using data from the Clinical Practice Research Datalink. Current asthma status, asthma medication and oral antibiotic use within 3 days of ALRTI infection was determined. Treatment frequency was calculated by asthma status. Mixed-effect regression models were used to explore between-practice variation and treatment determinants.ResultsThere were 127,976 ALRTIs reported among 110,418 patients during the study period, of whom 17,952 (16%) had asthma. Respectively, 81 and 79% of patients with and without asthma received antibiotics, and 41 and 15% asthma medication. There were significant differences in between-practice prescribing for all treatments, with greatest differences seen for oral steroids (odds ratio (OR) 18; 95% CI 7–82 and OR = 94; 33–363, with and without asthma) and asthma medication only (OR 7; 4–18 and OR = 17; 10–33, with and without asthma).Independent predictors of antibiotic prescribing among patients with asthma included fewer previous ALRTI presentations (≥2 vs. 0 previous ALRTI: OR = 0.25; 0.16–0.39), higher practice (OR = 1.47; 1.35–1.60 per SD) and prior antibiotic prescribing (3+ vs. 1 prescriptions OR = 1.28; 1.04–1.57) and concurrent asthma medication (OR = 1.44; 1.32–1.57). Independent predictors of asthma medication in patients without asthma included higher prior asthma medication prescribing (≥7 vs. 0 prescriptions OR = 2.31; 1.83–2.91) and concurrent antibiotic prescribing (OR = 3.59; 3.22–4.01).ConclusionFindings from the study indicate that antibiotics are over-used for ALRTI, irrespective of asthma status, and asthma medication is over-used in patients without asthma, with between-practice variation suggesting considerable clinical uncertainty. Further research is urgently needed to clarify the role of these medications for ALRTI.

The risk of respiratory tract infections and antibiotic use in a general population and among people with asthma

“…Our results are in line with a previous study where significantly more females than males (both asthmatic and non-asthmatic subjects) were prescribed antibiotics in both France and Italy [ 12 ]. On the contrary, females were significantly less likely, in comparison to males, to be prescribed antibiotics in both asthmatic and non-asthmatic subjects in the UK [ 11 ].…”

“…Individuals with respiratory disease, including asthma, may be particularly vulnerable to respiratory tract infections [ 11 , 12 ]. Other confirmed or suspected risk factors for respiratory tract infections in adults are active and passive smoking [ 13 , 14 ], low serum vitamin D levels [ 15 ], lack of physical activity [ 16 ], children in household at daycare [ 17 ], sudden changes of temperature at work [ 18 ], lack of handwashing, psychological stress, shift work [ 19 , 20 ], and duration and quality of sleep [ 21 ].…”

Macrophages Orchestrate Airway Inflammation, Remodeling, and Resolution in Asthma

“…Despite bactericidal and anti-inflammatory effects, long term use of antibiotics has been linked to the generation of antibiotic resistant bacterial strains in severe asthma [ 245 , 250 , 251 ], potentially limiting their utility. The possible generation of antibiotic resistant microbes has elicited a call to reduce overuse of antibiotics and pursue therapeutic avenues that involve enhancing host defense to invading microbes.…”

Inhaled antibiotic-loaded polymeric nanoparticles for the management of lower respiratory tract infections

“… 24 However, most recent investigation shows that amoxicillin and clarithromycin are the most commonly prescribed antibiotics from these drug groups for acute LRTIs. 25 In contrast, HAP treatment is limited to some specific groups of antibiotics including dihydrofolate-reductase inhibitors, lipoglycopeptides and oxazolidinone. 24 Most of these antibiotics target the bacterial DNA gyrase enzyme and show activity by inhibiting DNA replication, 26 thus reducing mutant selection and toxic side effects.…”