Reducing antibiotic repeat prescriptions for respiratory tract infections (RTIs) within primary care could be a ‘quick win’ for antimicrobial stewardship, a new study has revealed.
High rates of repeat antibiotic prescriptions, known as ‘within-episode’ prescriptions, were observed across England in a study among patients visiting their GP with RTIs.
Researchers found that twenty per cent of adults and ten per cent of children were given the same antibiotic within ten days of the initial prescription, despite current guidelines recommending a no or delayed antibiotic prescribing strategy for the vast majority of patients.
The findings, published in the Journal of Infection, highlight the importance of considering within-episode repeat prescriptions in antimicrobial stewardship interventions.
RTIs are one of the most common reasons people visit a GP in the UK and over half of these RTI consultations in UK primary care result in an antibiotic prescription. However, many RTIs are caused by a virus, and as such, ‘with-in episode’ prescriptions are one of the critical drivers of antimicrobial resistance.
The researchers analysed 905,964 RTI episodes recorded in the Clinical Practice Research Datalink (CPRD) from 530 English general practices. All individuals had a primary care RTI consultation for which an antibiotic was prescribed between March 2018 and February 2022. The researchers examined the number of patients who received a repeat antibiotic prescription within 28 days of the initial RTI and whether the RTI was a lower or upper RTI. Using statistical analysis, they aimed to identify factors that put patients at higher risk of requiring repeat prescriptions within the same episode of care.
Repeat antibiotic prescriptions within an episode are common, with nearly 20 per cent of adults and 10 per cent of children receiving a second course of antibiotics within the same episode of a lower RTI (chest infection). Almost half (48.3 per cent) of these repeat prescriptions involved the same antibiotic class, typically occurring ten days after the initial prescription.
Alastair Hay, a GP and Professor of primary care at the University of Bristol, and Principal Investigator on the study, said: ‘It seems implausible that repeat antibiotic courses will have any benefit given that there is clear evidence that children and adults without chronic lung disease do not benefit from a first course of antibiotics and that NICE recommends five-day antibiotic courses for the severest lower respiratory tract infections, such as pneumonia.’
The findings show that patients who regularly visited their GP with RTIs were more likely to be given a repeat prescription within the same episode of RTI. This was true for both adults and children, irrespective of the type of RTI being treated. Children younger than two years of age and adults older than 65 were also associated with ‘within-in episode’ prescriptions. Among those aged 2–64, allergic rhinitis, COPD, and oral corticosteroids were associated with repeat prescriptions.
Arief Lalmohamed, senior lecturer at University Medical Center Utrecht and lead author of the study added: ‘Repeat within-episode antibiotic use accounts for a significant proportion of all antibiotics prescribed for RTIs. In light of our findings, it’s clear that antimicrobial stewardship interventions must extend beyond initial antibiotic prescriptions to address within-episode repeats.’
