Within-episode repeat antibiotic prescriptions in patients with respiratory tract infections: A population-based
Arief Lalmohamed1, Roderick P Venekamp2, Albert Bolhuis3
1Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands; Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
Background:
Antimicrobial stewardship interventions mainly focus on initial antibiotic prescriptions, with few considering within-episode repeat prescriptions. We aimed to describe the magnitude, type and determinants of within-episode repeat antibiotic prescriptions in patients presenting to primary care with respiratory tract infections (RTIs).
Methods:
We conducted a population-based cohort study among 530 sampled English general practices within the Clinical Practice Research Datalink (CPRD). All individuals with a primary care RTI consultation for which an antibiotic was prescribed between March 2018 and February 2022. Main outcome measurement was repeat antibiotic prescriptions within 28 days of a RTI visit stratified by age (children vs. adults) and RTI type (lower vs. upper RTI). Multivariable logistic regression and principal components analyses were used to identify risk factors and patient clusters at risk for within-episode repeat prescriptions.
Findings:
905,964 RTI episodes with at least one antibiotic prescription were identified. In adults, 19.9% (95% CI 19.3-20.5%) had at least one within-episode repeat prescription for a lower RTI, compared to 10.5% (95% CI 10.3-10.8%) for an upper RTI. In children, this was around 10% irrespective of RTI type. The majority of repeat prescriptions occurred a median of 10 days after the initial prescription and was the same antibiotic class in 48.3% of cases. Frequent RTI related GP visits and prior within-RTI-episode repeat antibiotic prescriptions were main factors associated with repeat prescriptions in both adults and children irrespective of RTI type. Young (<2 years) and older (65+) age were associated with repeat prescriptions. Among those aged 2-64 years, allergic rhinitis, COPD and oral corticosteroids were associated with repeat prescriptions.
Interpretations:
Repeat within-episode antibiotic use accounts for a significant proportion of all antibiotics prescribed for RTIs, with same class antibiotics unlikely to confer clinical benefit and is therefore a prime target for future antimicrobial stewardship interventions.
Insights
Repeat antibiotic prescriptions for respiratory tract infections (RTIs) are common, especially for lower RTIs in adults. Targeting these within-episode repeat prescriptions is crucial for antimicrobial stewardship.
Area of Science:
- Public Health
- Infectious Diseases
- Pharmacology
Background:
- Antimicrobial stewardship often overlooks repeat antibiotic prescriptions within a single illness episode.
- Focusing on initial prescriptions misses opportunities to optimize antibiotic use for respiratory tract infections (RTIs).
Purpose of the Study:
- To quantify the occurrence of within-episode repeat antibiotic prescriptions for RTIs in primary care.
- To identify patient and infection-related factors associated with these repeat prescriptions.
Main Methods:
- Population-based cohort study using the Clinical Practice Research Datalink (CPRD) in England.
- Analysis of 905,964 RTI episodes with antibiotic prescriptions between March 2018 and February 2022.
- Stratified analysis by age and RTI type, employing multivariable logistic regression and principal components analysis.
Main Results:
- Nearly 20% of adult lower RTI episodes and 10.5% of upper RTI episodes involved repeat antibiotic prescriptions.
- In children, repeat prescriptions occurred in approximately 10% of episodes, regardless of RTI type.
- Frequent RTI-related GP visits and prior repeat prescriptions were key risk factors; younger (<2) and older (65+) adults were also at higher risk.
Conclusions:
- Within-episode repeat antibiotic use constitutes a substantial portion of antibiotic prescribing for RTIs.
- Prescribing the same antibiotic class for repeat prescriptions offers unlikely clinical benefit.
- These repeat prescriptions represent a significant target for future antimicrobial stewardship initiatives.
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