Trends in antibiotic prescribing in primary care for clinical syndromes subject to national recommendations to reduce antibiotic resistance, UK 1995-2011: analysis of a large database of primary care consultations

Hawker, Jeremy; Smith, Susan M; Smith, Gillian; Morbey, Roger; Johnson, Alan P.; Fleming, Douglas; Shallcross, Laura; Hayward, Andrew

doi:10.1093/jac/dku291

Cited by 139 publications

(110 citation statements)

References 18 publications

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“…1,2 Sore throats resulted in 92 million estimated visits by adults to primary care practices and emergency departments in the United States between 1997 and 2010, averaging 6.6 million annually; with unnecessary antibiotic prescribing costs of at least $500 million. 3 Antibiotics are prescribed at 60% of UK primary care sore throat consultations, 4 and the trend is not decreasing 3,5 despite the low risks of suppurative complications, limited symptomatic benefit, 6 and national guidelines advising against prescriptions. 7,8 There is a need to find alternative strategies that reduce symptoms, reduce the burden of acute illness, and reduce antibiotic consumption.…”

Section: Resultsmentioning

confidence: 99%

Effect of Oral Dexamethasone Without Immediate Antibiotics vs Placebo on Acute Sore Throat in Adults

Hayward

Moore

Jawad

et al. 2017

JAMA

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IMPORTANCE Acute sore throat poses a significant burden on primary care and is a source of inappropriate antibiotic prescribing. Corticosteroids could be an alternative symptomatic treatment.OBJECTIVE To assess the clinical effectiveness of oral corticosteroids for acute sore throat in the absence of antibiotics. Double-blind, placebo-controlled randomized trial (April 2013-February 2015 28-day follow-up completed April 2015) conducted in 42 family practices in South and West England, enrolled 576 adults recruited on the day of presentation to primary care with acute sore throat not requiring immediate antibiotic therapy. DESIGN, SETTING, AND PARTICIPANTSINTERVENTIONS Singleoraldoseof10mgofdexamethasone(n = 293)oridenticalplacebo(n = 283). MAIN OUTCOMES AND MEASURESPrimary: proportion of participants experiencing complete resolution of symptoms at 24 hours. Secondary: complete resolution at 48 hours, duration of moderately bad symptoms (based on a Likert scale, 0, normal; 6, as bad as it could be), visual analog symptom scales (0-100 mm; 0, no symptom to 100, worst imaginable), health care attendance, days missed from work or education, consumption of delayed antibiotics or other medications, adverse events. RESULTSOf 565 eligible randomized participants (median age, 34 years [interquartile range, 26.0-45.5 years]; 75.2% women; 100% completed the intervention), 288 received dexamethasone and 277, placebo. At 24 hours, participants receiving dexamethasone were not more likely than those receiving placebo to have complete symptom resolution. Results were similar among those who were not offered an antibiotic prescription and those who were offered a delayed antibiotic prescription. At 48 hours, more participants receiving dexamethasone than placebo had complete symptom resolution. This difference also was observed in patients not offered delayed antibiotics. There were no significant differences in any other secondary outcomes. Resolution of Symptoms at 24 h (Primary Outcome)

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Section: Resultsmentioning

confidence: 99%

Effect of Oral Dexamethasone Without Immediate Antibiotics vs Placebo on Acute Sore Throat in Adults

Hayward

Moore

Jawad

et al. 2017

JAMA

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“…8 These findings suggest that practices responding to the prospect of widespread antibiotic resistance by reducing antibiotic prescribing are likely to experience reductions in their satisfaction ratings.…”

Section: Discussion Summarymentioning

confidence: 97%

“…7 That there is scope for further reduction is suggested by evidence that many upper respiratory tract infections of a mainly viral origin continue to be treated with antibiotics, with one study reporting antibiotic prescriptions issued for 51% of patients presenting with coughs and colds. 8 There may be a trade-off between the wish to nurture the doctor-patient relationship and antibiotic stewardship. 4 This trade-off may be an important obstacle to the appropriate limitation of antibiotic prescribing, especially in the context of growing concerns about antibiotic resistance.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic prescribing and patient satisfaction in primary care in England: cross-sectional analysis of national patient survey data and prescribing data

et al. 2015

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BackgroundConcerns about adverse effects on patient satisfaction may be an important obstacle to attempts to curtail antibiotic prescribing. AimTo determine the relationship between antibiotic prescribing in general practice and reported patient satisfaction. Design and settingRetrospective cross-sectional study of general practices in England. Method ResultsThe final dataset consisted of 7800 (95.5%) practices. A total of 33.7 million antibiotic prescriptions were issued to a registered population of 53.8 million patients. Antibiotic prescribing volume was a significant positive predictor of all 'doctor satisfaction' and 'practice satisfaction' scores in the GPPS, and was the strongest predictor of overall satisfaction out of 13 prescribing variables. A theoretical 25% reduction in antibiotic prescribing volume would be associated with 0.5-1.0% lower patient satisfaction scores, a drop of 3-6 centile points in national satisfaction ranking. ConclusionPatients were less satisfied in practices with frugal antibiotic prescribing. A cautious approach to antibiotic prescribing may require a trade-off in terms of patient satisfaction.

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“…However, in a recent survey of antibiotic prescribing in UK general practice, half of all patients consulting for these conditions were prescribed an antibiotic. 3 Many GPs prescribe for minor infections such as sore throat or otitis media because of concerns over the risk of suppurative complications such as quinsy or mastoiditis. Such concerns are not borne out by the data: hundreds of patients require antibiotic treatment to prevent one adverse event.…”

Section: Antibiotic Use In Primary Carementioning

confidence: 99%

Antibiotic overuse: a key driver of antimicrobial resistance

Shallcross

Davies²

2014

Br J Gen Pract

197

153

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Trends in antibiotic prescribing in primary care for clinical syndromes subject to national recommendations to reduce antibiotic resistance, UK 1995-2011: analysis of a large database of primary care consultations

Cited by 139 publications

References 18 publications

Effect of Oral Dexamethasone Without Immediate Antibiotics vs Placebo on Acute Sore Throat in Adults

Effect of Oral Dexamethasone Without Immediate Antibiotics vs Placebo on Acute Sore Throat in Adults

Antibiotic prescribing and patient satisfaction in primary care in England: cross-sectional analysis of national patient survey data and prescribing data

Antibiotic overuse: a key driver of antimicrobial resistance

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