. 2019 Feb 27:364:l440.

doi: 10.1136/bmj.l440.

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

Koen B Pouwels^{1

2

3}, Susan Hopkins^{4

5

6}, Martin J Llewelyn^{7

8}, Ann Sarah Walker^{6

9}, Cliodna Am McNulty¹⁰, Julie V Robotham^{11

6}

Affiliations

¹ Modelling and Economics Unit, National Infection Service, Public Health England, London NW9 5EQ, UK k.b.pouwels@gmail.com.
² Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.
³ Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
⁴ Healthcare-Associated Infection and Antimicrobial Resistance Department, National Infection Service, Public Health England, London, UK.
⁵ Directorate of Infection, Royal Free London NHS Foundation Trust, London, UK.
⁶ National Institute for Health Research Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, Oxford, UK.
⁷ Department of Global Health and Infection, Brighton and Sussex Medical School, Falmer, Brighton, UK.
⁸ Department of Microbiology and Infection, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
⁹ Nuffield Department of Medicine, University of Oxford, UK.
¹⁰ Public Health England Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Gloucester, UK.
¹¹ Modelling and Economics Unit, National Infection Service, Public Health England, London NW9 5EQ, UK.

PMID: 30814052
PMCID: PMC6391655
DOI: 10.1136/bmj.l440

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

Koen B Pouwels et al. BMJ. 2019.

. 2019 Feb 27:364:l440.

doi: 10.1136/bmj.l440.

Authors

Koen B Pouwels^{1

2

3}, Susan Hopkins^{4

5

6}, Martin J Llewelyn^{7

8}, Ann Sarah Walker^{6

9}, Cliodna Am McNulty¹⁰, Julie V Robotham^{11

6}

Affiliations

¹ Modelling and Economics Unit, National Infection Service, Public Health England, London NW9 5EQ, UK k.b.pouwels@gmail.com.
² Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.
³ Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
⁴ Healthcare-Associated Infection and Antimicrobial Resistance Department, National Infection Service, Public Health England, London, UK.
⁵ Directorate of Infection, Royal Free London NHS Foundation Trust, London, UK.
⁶ National Institute for Health Research Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, Oxford, UK.
⁷ Department of Global Health and Infection, Brighton and Sussex Medical School, Falmer, Brighton, UK.
⁸ Department of Microbiology and Infection, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
⁹ Nuffield Department of Medicine, University of Oxford, UK.
¹⁰ Public Health England Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Gloucester, UK.
¹¹ Modelling and Economics Unit, National Infection Service, Public Health England, London NW9 5EQ, UK.

PMID: 30814052
PMCID: PMC6391655
DOI: 10.1136/bmj.l440

Abstract

Objective: To evaluate the duration of prescriptions for antibiotic treatment for common infections in English primary care and to compare this with guideline recommendations.

Design: Cross sectional study.

Setting: General practices contributing to The Health Improvement Network database, 2013-15.

Participants: 931 015 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 measures: The 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.

Results: The 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.

Conclusion: For 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.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

Figures

**Fig 1**
Durations of antibiotic prescriptions for various indications

See this image and copyright information in PMC

Comment in

Duration of antibiotic treatment for common infections frequently exceeds recommended guidelines, potentially impacting antimicrobial resistance.
Zhang N. Zhang N. Evid Based Nurs. 2020 Jul;23(3):89. doi: 10.1136/ebnurs-2019-103116. Epub 2019 Sep 17. Evid Based Nurs. 2020. PMID: 31530571 No abstract available.
Antibiotische Therapie: Behandlungsdauer häufiger Infekte in der Praxis.
[No authors listed] [No authors listed] Laryngorhinootologie. 2020 Nov;99(11):755-756. doi: 10.1055/a-1264-3815. Epub 2020 Oct 27. Laryngorhinootologie. 2020. PMID: 33111289 German. No abstract available.

References

1. Smieszek T, Pouwels KB, Dolk FCK, et al. Potential for reducing inappropriate antibiotic prescribing in English primary care. J Antimicrob Chemother 2018;73(suppl_2):ii36-43. 10.1093/jac/dkx500 - DOI - PMC - PubMed
1. G7 2016 in Japan: PM press statement - GOV.UK. 2016. www.gov.uk/government/speeches/g7-2016-in-japan-pm-press-statement
1. Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011. JAMA 2016;315:1864-73. 10.1001/jama.2016.4151 - DOI - PubMed
1. Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ 2010;340:c2096. 10.1136/bmj.c2096 - DOI - PubMed
1. Fisher H, Oluboyede Y, Chadwick T, et al. Continuous low-dose antibiotic prophylaxis for adults with repeated urinary tract infections (AnTIC): a randomised, open-label trial. Lancet Infect Dis 2018;18:957-68. 10.1016/S1473-3099(18)30279-2 - DOI - PMC - PubMed

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

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

Authors

Affiliations

Abstract

Conflict of interest statement

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Medical