Antibiotic treatment failure in four common infections in UK primary care 1991-2012: longitudinal analysis

Abstract

Objective To characterise failure of antibiotic treatment in primary care in the United Kingdom in four common infection classes from 1991 to 2012.Design Longitudinal analysis of failure rates for first line antibiotic monotherapies associated with diagnoses for upper and lower respiratory tract infections, skin and soft tissue infections, and acute otitis media. Setting Routine primary care data from the UK Clinical Practice Research Datalink (CPRD).Main outcome measures Adjusted rates of treatment failure defined by standardised criteria and indexed to year 1 (1991=100).Results From 58 million antibiotic prescriptions in CPRD, we analysed 10 967 607 monotherapy episodes for the four indications: 4 236 574 (38.6%) for upper respiratory tract infections; 3 148 947 (28.7%) for lower respiratory tract infections; 2 568 230 (23.4%) for skin and soft tissue infections; and 1 013 856 (9.2%) for acute otitis media. In 1991, the overall failure rate was 13.9% (12.0% for upper respiratory tract infections; 16.9% for lower respiratory tract infections; 12.8% for skin and soft tissue infections; and 13.9% for acute otitis media). By 2012, the overall failure rate was 15.4%, representing an increase of 12% compared with 1991 (adjusted value indexed to first year (1991) 112, 95% confidence interval 112 to 113). The highest rate was seen in lower respiratory tract infections (135, 134 to 136). While failure rates were below 20% for most commonly prescribed antibiotics (amoxicillin, phenoxymethylpenicillin (penicillin-V), and flucloxacillin), notable increases were seen for trimethoprim in the treatment of upper respiratory tract infections (from 29.2% in 1991-95 to 70.1% in 2008-12) and for ciprofloxacin (from 22.3% in 1991-95 to 30.8% in 2008-12) and cefalexin (from 22.0% in 1991-95 to 30.8% in 2008-12) in the treatment of lower respiratory tract infections. Failure rates for broad spectrum penicillins, macrolides, and flucloxacillin remained largely stable.Conclusions From 1991 to 2012, more than one in 10 first line antibiotic monotherapies for the selected infections were associated with treatment failure. Overall failure rates increased by 12% over this period, with most of the increase occurring in more recent years, when antibiotic prescribing in primary care plateaued and then increased.

Persistence of antimicrobial resistance in respiratory streptococci

“…Antimicrobial resistance poses a substantial threat to public health as it is related to treatment failure, prolonged hospitalisation, increased cost of care and increased mortality [1][2][3][4]. Both ecological studies and randomised controlled trials in individual patients have demonstrated a link between antibiotic use and resistance [5][6][7].…”

Amoxicillin is associated with a lower risk of further antibiotic prescriptions for lower respiratory tract infections in primary care – A database analysis spanning over 30 years

“…Yet 6.2% of our population even received two antibiotic courses for LRTI within two weeks. Treatment failure rates of 20% have been described previously but these included prescriptions for pneumonia and further antibiotics for all indications [9]. We present more specific data for LRTI, which can assist to plan future work.…”

“…Amoxicillin treats Streptococcus pneumoniae , the most common bacterial cause of LRTI, hence our finding of fewer repeat prescriptions after initial amoxicillin therapy could be clinically plausible [12]. Whilst the effect sizes were small, LRTI are very common [9]. Hence even small differences of less than 1% could theoretically result in meaningful differences in antibiotic prescriptions due to the size of the population, if they were true.…”

Cualificación y experiencia de los vendedores de droguería para la dispensación de amoxicilina en una comuna de Santiago de Cali, Colombia

“…Este antibiótico, como muchos otros, puede presentar un aumento de su consumo en ciertos períodos del año, tal como los meses de invierno [17], aumentando sus probabilidades de uso inadecuado. A pesar de ser el antibiótico de mayor prescripción en otitis, infecciones del tracto respiratorio, de la piel y de los tejidos blandos, Currie y colaboradores [11] mostraron que la amoxicilina era la de menor tasa de fracaso del tratamiento.…”

“…Esta se emplea en diagnósticos como la otitis [10,11], sinusitis [10], amigdalitis [10], infecciones del tracto respiratorio [11], infecciones de la piel y tejidos blandos [11], entre otros. Según varios estudios, la amoxicilina y las penicilinas de amplio espectro son el antibiótico y el subgrupo farmacológico más consumido a nivel comunitario, en Colombia [7,[12][13][14], en América Latina [15] y en distintos países del mundo [16][17][18][19][20][21][22].…”