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Antibiotic treatment failure in primary care

BMJ 2014; 349 doi: (Published 02 October 2014) Cite this as: BMJ 2014;349:g5970
  1. Samuel Coenen, assistant professor12,
  2. Herman Goossens, professor1
  1. 1Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
  2. 2Centre for General Practice, Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
  1. Correspondence to: S Coenen samuel.coenen{at}

Resistance is only part of the problem, and probably a small part

In the treatment of bacterial infections, antibiotic failure because of antimicrobial resistance is an extremely unfortunate reality experienced worldwide, especially in countries with high consumption of broad spectrum antibiotics in outpatients.1 To date the extent of such antibiotic treatment failure in primary care, where most antibiotics are being prescribed and infections are still among the commonest reasons for consultation, has been given little attention. In a linked paper, Currie and colleagues (doi:10.1136/bmj.g5493), report on their attempt to characterise treatment failure in primary care in the United Kingdom using routine primary care data linked in a unique resource, the UK Clinical Practice Research Datalink (CPRD).2 Their longitudinal analysis comprised nearly 11 million antibiotic monotherapies associated with diagnoses for upper and lower respiratory tract infections, skin and soft tissue infections, and acute otitis media from 1991 to 2012. Their results suggest that more than one in 10 monotherapies were associated with failure, that overall rates of failure had increased, particularly in lower respiratory tract infections, and that most of the increase had occurred in more recent years, when rates in primary care were no longer decreasing but had plateaued and …

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