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Safety of Reduced Antibiotic Prescribing for RTIs

BMJ; ePub 2016 Jul 4; Gulliford, Moore, et al

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In the primary care setting, general practices that adopt a policy to reduce antibiotic prescribing for respiratory tract infections (RTIs) might expect a slight increase in the incidence of treatable pneumonia and peritonsillar abscess, according to a recent cohort study. The study of registered patients with 45.5 million person years of follow-up from 2005 to 2014 also stated that no increase is likely in mastoiditis, empyema, bacterial meningitis, intracranial abscess, or Lemierre’s syndrome. Researchers found:

• During the study period the proportion of RTI consultations with antibiotics prescribed decreased from 53.9% to 50.5% in men and from 54.5% to 51.5% in women.

• New episodes of meningitis, mastoiditis, and peritonsillar abscess decreased annually by 5.3%, 4.6%, and 1.0%, respectively, whereas new episodes of pneumonia increased by 0.4%.

• The adjusted relative risk increases for a 10% reduction in antibiotic prescribing were 12.8% for pneumonia and 9.9% for peritonsillar abscess.

• Mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre’s syndrome were similar in frequency at low prescribing and high prescribing practices.

Citation: Gulliford MC, Moore MV, Little P, et al. Safety of reduced prescribing for self limiting respiratory tract infections in primary care: Cohort study using electronic health records. [Published online ahead of print July 4, 2016]. BMJ. doi:http://dx.doi.org/10.1136/bmj.i3410.

Commentary: Viruses are the cause of most uncomplicated upper respiratory tract infections and antibiotics do not improve outcomes of these viral infections. Nonetheless, antibiotics continue to be prescribed for over a third of common colds as well as even more frequently in non-bacterial sinusitis and bronchitis.1 Over-prescribing of antibiotics leads to the development of increasing antibiotic resitance both for individuals and within the community as a whole. Antibiotics are over-prescribed for 2 main reasons—to meet patient expectations for treatment with an antibiotic and because of fear that not treating with an antibiotic will leave untreated a bacterial infection that might go on to harm a patient. While this observational study suggests that there might be a small change in the incidence of pneumonia and peritonsillar abscess with decreased use of antibiotics, the change is small and may reflect a change in the ambient incidence of those 2 diseases over the time frame studied, rather than a causal relationship between decreased antibiotic use and those outcomes. —Neil Skolnik, MD

1. Gulliford M, Latinovic R, Charlton J, Little P, van Staa T, Ashworth M. Selective decrease in consultations and antibiotic prescribing for acute respiratory tract infections in UK primary care up to 2006. J Public Health (Oxf). 2009;31:512-20. doi:10.1093/pubmed/fdp081.

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