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Primary Care

Antibiotic prescribing in general practice and hospital admissions for peritonsillar abscess, mastoiditis, and rheumatic fever in children: time trend analysis

BMJ 2005; 331 doi: (Published 04 August 2005) Cite this as: BMJ 2005;331:328
  1. M Sharland, consultant in paediatric infectious diseases1,
  2. H Kendall, prescribing services manager2,
  3. D Yeates, computer scientist, health care epidemiology unit3,
  4. A Randall, clinical tutor3,
  5. G Hughes, senior research scientist4,
  6. P Glasziou, professor of evidence based medicine3,
  7. D Mant, professor of general practice (
  1. 1 Paediatric Infectious Diseases Unit, St George's Hospital, London SW17 0QT
  2. 2 Pharmaceutical Directorate, Prescription Pricing Authority, Newcastle upon Tyne NE1 6SN
  3. 3 Oxford University Division of Public Health and Primary Care, Oxford OX3 7LF
  4. 4 GPRD Division, Medicines and Healthcare Products Regulatory Agency, London SW8 5NQ
  1. Correspondence to: D Mant
  • Accepted 18 May 2005


Antibiotic resistance is an increasing problem in paediatric practice. General practitioners in the United Kingdom have consequently been exhorted to minimise antibiotic prescribing for childhood upper respiratory infections.1 However, some data suggest an association between reduced prescribing and an increased incidence of rare complications of bacterial infection.24 We report national data on community prescribing of antibiotics and hospital admissions for peritonsillar abscess, mastoiditis, and rheumatic fever in children during 1993-2003 (community prescribing) and 1993-2002 (hospital admissions).

Participants, methods, and results

We took prescribing data from the Prescription Pricing Authority's database for England (which collates information on drugs issued by pharmacists) and from the IMS Disease Analyzer Mediplus UK database (which contains electronic consultation data from about 130 computerised practices). We extracted hospital admission data from the hospital episode statistics for England using coding from the international classification of diseases, ninth and 10th revisions (ICD-9, ICD-10): 475 and J36 (quinsy); 390-2 and I00-I02 (rheumatic fever); and 383 and H70 (mastoiditis). The operation codes (OPCS 3 and OPCS 4) that we used for identifying cases of simple or cortical mastoidectomy were 200, 201.2, 201.9, D10.3, and D10.4, but we excluded cases with …

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