| アブストラクト | OBJECTIVE: To evaluate the duration of prescriptions for antibiotic treatment for common infections in English primary care and to compare this with guideline recommendations. DESIGN: Cross sectional study. SETTING: General practices contributing to The Health Improvement Network database, 2013-15. PARTICIPANTS: 931 015 consultations that resulted in an antibiotic prescription for one of several indications: acute sinusitis, acute sore throat, acute cough and bronchitis, pneumonia, acute exacerbation of chronic obstructive pulmonary disease (COPD), acute otitis media, acute cystitis, acute prostatitis, pyelonephritis, cellulitis, impetigo, scarlet fever, and gastroenteritis. MAIN OUTCOME MEASURES: The main outcomes were the percentage of antibiotic prescriptions with a duration exceeding the guideline recommendation and the total number of days beyond the recommended duration for each indication. RESULTS: The most common reasons for antibiotics being prescribed were acute cough and bronchitis (386 972, 41.6% of the included consultations), acute sore throat (239 231, 25.7%), acute otitis media (83 054, 8.9%), and acute sinusitis (76 683, 8.2%). Antibiotic treatments for upper respiratory tract indications and acute cough and bronchitis accounted for more than two thirds of the total prescriptions considered, and 80% or more of these treatment courses exceeded guideline recommendations. Notable exceptions were acute sinusitis, where only 9.6% (95% confidence interval 9.4% to 9.9%) of prescriptions exceeded seven days and acute sore throat where only 2.1% (2.0% to 2.1%) exceeded 10 days (recent guidance recommends five days). More than half of the antibiotic prescriptions were for longer than guidelines recommend for acute cystitis among females (54.6%, 54.1% to 55.0%). The percentage of antibiotic prescriptions exceeding the recommended duration was lower for most non-respiratory infections. For the 931 015 included consultations resulting in antibiotic prescriptions, about 1.3 million days were beyond the durations recommended by guidelines. CONCLUSION: For most common infections treated in primary care, a substantial proportion of antibiotic prescriptions have durations exceeding those recommended in guidelines. Substantial reductions in antibiotic exposure can be accomplished by aligning antibiotic prescription durations with guidelines. |
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| 投稿日 | 2019/3/1 |
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| 投稿者 | Pouwels, Koen B; Hopkins, Susan; Llewelyn, Martin J; Walker, Ann Sarah; McNulty, Cliodna Am; Robotham, Julie V |
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| ジャーナル名 | BMJ (Clinical research ed.) |
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| 組織名 | Modelling and Economics Unit, National Infection Service, Public Health England,;London NW9 5EQ, UK k.b.pouwels@gmail.com.;Department of Health Sciences, Global Health, University Medical Centre;Groningen, University of Groningen, Groningen, Netherlands.;Health Economics Research Centre, Nuffield Department of Population Health,;University of Oxford, Oxford, UK.;Healthcare-Associated Infection and Antimicrobial Resistance Department, National;Infection Service, Public Health England, London, UK.;Directorate of Infection, Royal Free London NHS Foundation Trust, London, UK.;National Institute for Health Research Health Protection Research Unit on;Healthcare Associated Infections and Antimicrobial Resistance, Oxford, UK.;Department of Global Health and Infection, Brighton and Sussex Medical School,;Falmer, Brighton, UK.;Department of Microbiology and Infection, Brighton and Sussex University;Hospitals NHS Trust, Brighton, UK.;Nuffield Department of Medicine, University of Oxford, UK.;Public Health England Primary Care Unit, Microbiology Department, Gloucestershire;Royal Hospital, Gloucester, UK.;London NW9 5EQ, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/30814052/ |
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