More than 1 million days of antibiotics could be cut if guidelines were followed

A large proportion of antibiotics given for common infections in primary care are prescribed for longer than guideline recommendations, research published in the BMJ
(27 February 2019) has found.

The research also revealed that more than 1 million days’ worth of antibiotics use for respiratory tract indications could be cut if guidelines were followed correctly.

The authors carried out a cross-sectional study of general practices contributing to The Health Improvement Network Database. In total there were 931,015 consultations, carried out between 2013 and 2015, that resulted in an antibiotic prescription for 1 of 13 common indications, including acute sore throat, cough, middle ear infection and bronchitis. Chronic and recurrent conditions were excluded, as were repeat prescriptions.

The researchers examined the percentage of antibiotic prescriptions with a duration exceeding recommendations in the Public Health England 2013 guideline and the total number of days beyond the recommended duration for each indication. 

It was found that antibiotic treatments for upper respiratory tract indications and acute cough and bronchitis accounted for more than two-thirds of the total prescriptions considered, while 80% or more of these treatment courses exceeded guideline recommendations.

Although fewer prescriptions exceeded recommended durations for non-respiratory tract conditions, more than half (54.6%) of the antibiotic prescriptions for acute cystitis among women were for longer than recommended.

Exceptions were acute sinusitis, for which only 9.6% of prescriptions were longer than the seven days recommended by the guidelines, and acute sore throat where only 2.1% exceeded ten days, compared to the recommended five days.

The researchers calculated that if all patients receiving antibiotics for the included indications had received treatment for the durations recommended by guidelines over the study period, it would equate to 1.1 million fewer days of antibiotic use for respiratory tract indications and 100,000 fewer days for acute cystitis among females.

They said that their findings indicated “substantial scope” for reducing antibiotic prescribing through better adherence to recommended durations of antibiotic treatment. But said that a better understanding of why clinicians tend to prescribe antibiotic courses that are longer than guideline recommendations, especially for respiratory tract infections, was needed.

“Poor guideline adherence may result from several factors, including lack of awareness and scepticism of specific guideline recommendations,” they said.