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

Liberty Peters



Antibiotic resistance is a growing challenge across the globe. As such, there have been increasing efforts towards reducing unnecessary or inappropriate antibiotic prescribing of antibiotics. There is limited evidence regarding the contribution of excessive antibiotic treatment duration to antibiotic overuse in the primary care setting. In this cross-sectional study, 931,015 consultations for 13 different indications that led to antibiotic prescriptions were included in the analysis to study 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. Data were obtained from The Health Improvement Network (THIN), a primary care database representative of the general UK population, from 2013 to 2015. The 13 indications were: 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. The Public Health England (PHE) provided guidelines for antibiotic regimens. The most common indications for antibiotics were acute cough and bronchitis (41.6%), acute sore throat (25.7%), acute otitis media (8.9%), and acute sinusitis (8.2%). Researchers found that upper respiratory tract infections and acute cough and bronchitis accounted for more than two-thirds of total prescriptions, and 80% or more of these treatment courses exceeded guideline recommendations (acute cough and bronchitis: 85.6%; acute sore throat (5-day recommended duration): 83.8%; acute COPD exacerbation: 89.0%). A notable exception was seen in the management of acute sinusitis, for which only 9.6% of prescriptions were longer than the guideline recommendation. For all conditions grouped together, antibiotic regimens were prescribed for about 1.3 million days beyond the durations recommended by guidelines. In summary, this study underscores that for some of the most common infections in primary care, antibiotics are often prescribed for a longer duration than is recommended by current guidelines.

Click to read the study in BMJ

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