Prescribing of antibiotics and admissions for respiratory tract infections in England
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7471.879 (Published 14 October 2004) Cite this as: BMJ 2004;329:879
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We read with great interest the report of Majeed and colleagues that
recent declines in antibiotic prescribing for respiratory tract infection
in England (1996–2002) are associated with an increase in hospital
admissions for respiratory tract infection (1). These data complement our
recently published analyses showing that the recent decline in antibiotic
prescribing for lower respiratory tract infection in England and Wales
(1993/4–1999/00) may have been associated with a concurrent increase in
excess winter pneumonia mortality (2). Taken together, these studies show
a relationship between antibiotic prescribing trends and patient outcomes
using different approaches, outcome measures and datasets. They support
the recommendation of the SMAC report on antimicrobial resistance that
advice on appropriate antibiotic prescribing should be restricted to self-
limiting upper respiratory and urinary tract infections, rather than
potentially life-threatening lower respiratory tract infections (3).
Lower respiratory tract infection covers a spectrum of illness, from
self-limiting infection to pneumonia. General practitioners are faced with
the challenge of identifying which patients with lower respiratory tract
infection are at risk of hospital admission or mortality and treating them
appropriately. Without the benefit of specialist diagnostic techniques
such as radiography, which are rarely available in general practice, it
may be appropriate to restrict the prescribing of antibiotics to patients
most at risk of adverse outcomes, such as those with chronic coronary or
respiratory diseases, and the elderly with comorbidity. It is of concern
that recent declines in antibiotic prescribing have taken place across all
age groups with, for example, elderly men (aged 75 and over) being
affected by a 10% decline in total antibiotic prescribing between 1995 and
1998 (4).
If general practitioners are to reduce inappropriate antibiotic
prescribing while safeguarding patient health, further research is
urgently required on which they can base their management decisions. In
particular, patient-level observational data is needed to assess potential
risk factors for morbidity and mortality among patients with lower
respiratory tract infection in UK general practice, and to clarify the
role of delayed antibiotic prescription in adverse outcomes. Only then can
the impact of recent changes in antibiotic prescribing policy on patient
outcomes be established with certainty.
Competing interests:
None declared
Competing interests: No competing interests
Re: Antibiotics and patient outcomes - further research is needed
Dear Sir,
Penicillin is the drug of choice in respiratory infections.
Penicillin should not be restricted, but reinforced.
Untreated streptococcal infection results in post-streptococcal-
reactive-disease in 3 percent.
Evidence Based Medicine is nonsense if we do not look into history:
Waves of respiratory infections killed people in every winter - winter bed
crisis of the old.
Much more research into these topics is necessary.
And we should look into NATURE 21 October 2004:
"Antibiotics crisis.
Market forces fail to deliver."
"Antibiotics at the crossroads."
The author ends with this "History of Medicine":
"2000 BC - Here, eat this root.
AD 1000 - That root is heathen. Here, say this prayer.
1850 - That prayer is superstition. Here, drink this potion.
1920 - That potion is snake oil. Here, swallow this pill.
1945 - That pill is ineffective. Here, take this penicillin.
1955 - Oops...bugs mutated. Here, take this tetracycline.
1960-1999 - 39 more "oops"... Here, take this more powerful
antibiotic.
2000 - The bugs have won! Here, eat this root." page 901
..
EBM is teaching us:
Here, eat this root.
Penicillin is not necessary in strep-throat.
What a crazy medicine in the name of science.
Sincerely Yours
Friedrich Flachsbart
C. Nathan: Antibiotics at the crossroads. Are we making the right
choices to bring new drugs to the marketplace?
Nature 2004;431:899-902
Competing interests:
None declared
Competing interests: No competing interests