TOPLINE:
Repeat, within-episode antibiotic treatment (often in the same class) for respiratory tract infections (RTIs) in adults and children accounts for ≥ 10% of overall antibiotic prescriptions across all types of RTIs, especially in older (65+ years) patients and young children (< 2 years).
METHODOLOGY:
- Researchers conducted a retrospective, population-based cohort study among 530 English general practices assessing within RTI episode repeat antibiotic prescription proportions in patients presenting to primary care from March 2018 to February 2022.
- The primary outcome was the proportion of episodes in which repeat antibiotic prescriptions were issued.
- An RTI episode was defined as the start of the first prescription and was considered extended if another RTI consult occurred ≤ 28 days. It ended 28 days after the last RTI consultation.
- The primary outcome was stratified by time, age, and type of RTI.
TAKEAWAY:
- A total of 905,964 lower or upper RTIs with ≥ 1 antibiotic prescription were identified; 48.6% and 89.9% of episodes were associated with upper RTI in adults and children, respectively (66%-90% were oral penicillin).
- Overall, 12.7% (95% CI, 12.5%-12.9%) of prescriptions were within-episode repeat; rates for adults were highest for lower RTI (19.9%) vs upper (10.5%), and similarly, slightly higher comparably in children.
- Repeat prescriptions were most common in children < 2 years with frequent general practitioner visits and prior within-episode repeat prescriptions (32.9%; 95% CI, 28.4%-37.0%) and in adults aged 65+ years (30.9%; 95% CI, 30.1%-31.8%).
- Repeat, within-episode risk factors included allergic rhinitis, oral corticosteroids use, and chronic obstructive pulmonary disease.
IN PRACTICE:
"[C]linicians should emphasise that a single-treatment course is likely to be microbiologically adequate and...remind patients that the natural history of many RTIs is considerably longer than most antibiotic treatment courses," the authors wrote.
SOURCE:
The study was led by Arief Lalmohamed from Utrecht University, Utrecht, The Netherlands, and appeared online in the Journal of Infection.
LIMITATIONS:
Limitations included missed antibiotic prescriptions, missing confounders, selection bias, and possible overestimated antibiotic consumption.
DISCLOSURES:
The study was not funded. The authors reported no conflicts of interest.
