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Antibiotic prescribing should be standardised across Europe

Antibiotic prescribing for respiratory illnesses should be standardised across Europe to help reduce inappropriate prescribing and resistance, say experts in a study published on today.

Antibiotic resistance is a major healthcare problem worldwide. Inappropriate antibiotic prescribing, particularly for respiratory illnesses, has been blamed for driving the problem. There is also good evidence that most antibiotic prescriptions do not help otherwise healthy patients with common respiratory tract infections get better any quicker.

So researchers of the EU funded Network of Excellence GRACE ( set out to describe variation in antibiotic prescribing for acute cough across Europe, and its impact on recovery.

The study involved 3,402 adults with a new or worsening cough or a possible lower respiratory tract infection. Patients were recruited from 14 primary care research networks in 13 European countries.

Overall, antibiotics were prescribed for 53% of patients, but prescribing ranged from 21% to nearly 90% across the networks. For example, patients in Slovakia, Italy, Hungary, Poland and Wales were at least twice as likely to be prescribed antibiotics than the overall average, while patients in Norway, Belgium and Sweden were at least four times less likely to be prescribed antibiotics than the overall average.

Major differences in the decision whether or not to prescribe an antibiotic remained, even after the researchers adjusted for symptoms, duration of illness, smoking, age, temperature, and existing conditions (co-morbidity).

Furthermore, this variation in antibiotic prescribing was not associated with clinically important differences in patient recovery.

Professor Chris Butler, of Cardiff University, who led the study, said: "This international collaborative research showed that the big differences in antibiotic prescribing between countries are not justified on clinical grounds. It therefore identifies a major opportunity for greater standardisation of care across Europe."