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Research article:

Antibiotic prescribing for common infections in UK general practice: variability and drivers

Reference:

Victoria Palin, Anna Mölter, Miguel Belmonte, Darren Ashcroft, Andrew White, William Welfare, Tjeerd van Staa(2018) Antibiotic prescribing for common infections in UK general practice: variability and drivers. Journal of Antimicrobial Chemotherapy, doi:

Link to article
Abstract
Objectives: To examine variations across general practices and factors associated with antibiotic prescribing for common infections in UK primary care to identify potential targets for improvement and optimisation of prescribing. Methods: Oral antibiotics prescribing for common infections were analysed using anonymised UK primary care electronic health records between 2000 and 2015 using the Clinical Practice Research Datalink (CPRD). The rate of prescribing for each condition was observed over time and the correlation of prescribing between each condition estimated within a practice. Drivers of prescribing were estimated using logistic regression in a matched patient cohort (1:1 by age, sex and date). Results: Over 8 million patient records were examined in 587 general practices in the UK. Practices varied considerably in their propensity to prescribe antibiotics and this variance increased over time (except in cases of urinary tract infection (UTI)). Change points in prescribing did not reflect updates to national guidelines and prescribing for different infectious conditions varied within practices. A previous history of antibiotic use significantly increased the risk of receiving a subsequent antibiotic (by 22-48% for patients with ≥ 3 antibiotic prescriptions in the past 12 months), as did higher BMI, history of smoking and flu vaccinations. Other drivers for receiving an antibiotic varied considerably for each condition. Conclusions: Large variability in antibiotic prescribing between practices was observed. Prescribing guidelines alone do not positively influence a change in prescribing, suggesting more targeted interventions are required to optimise antibiotic prescribing in the UK.
Author for correspondence
Victoria Palin
Email for correspondence
victoria.palin@manchester.ac.uk

Code list: res70: LRTI

46 codes in list

Code Coding system Description Entity type List name
H06..00 Read Acute bronchitis and bronchiolitis diagnostic res70: LRTI
H060.00 Read Acute bronchitis diagnostic res70: LRTI
H060000 Read Acute fibrinous bronchitis diagnostic res70: LRTI
H060.11 Read Acute wheezy bronchitis diagnostic res70: LRTI
H060300 Read Acute purulent bronchitis diagnostic res70: LRTI
H060400 Read Acute croupous bronchitis diagnostic res70: LRTI
H060500 Read Acute tracheobronchitis diagnostic res70: LRTI
H060600 Read Acute pneumococcal bronchitis diagnostic res70: LRTI
H060700 Read Acute streptococcal bronchitis diagnostic res70: LRTI
H060800 Read Acute haemophilus influenzae bronchitis diagnostic res70: LRTI
H060A00 Read Acute bronchitis due to mycoplasma pneumoniae diagnostic res70: LRTI
H060x00 Read Acute bacterial bronchitis unspecified diagnostic res70: LRTI
H060z00 Read Acute bronchitis NOS diagnostic res70: LRTI
H061.00 Read Acute bronchiolitis diagnostic res70: LRTI
H061000 Read Acute capillary bronchiolitis diagnostic res70: LRTI
H061200 Read Acute bronchiolitis with bronchospasm diagnostic res70: LRTI
H061300 Read Acute exudative bronchiolitis diagnostic res70: LRTI
H061z00 Read Acute bronchiolitis NOS diagnostic res70: LRTI
H062.00 Read Acute lower respiratory tract infection diagnostic res70: LRTI
H06z.00 Read Acute bronchitis or bronchiolitis NOS diagnostic res70: LRTI
H06z000 Read Chest infection NOS diagnostic res70: LRTI
H06z011 Read Chest infection diagnostic res70: LRTI
H06z100 Read Lower resp tract infection diagnostic res70: LRTI
H06z111 Read Respiratory tract infection diagnostic res70: LRTI
H06z112 Read Acute lower respiratory tract infection diagnostic res70: LRTI
H06z200 Read Recurrent chest infection diagnostic res70: LRTI
H24..11 Read Chest infection with infectious disease EC diagnostic res70: LRTI
H30..00 Read Bronchitis unspecified diagnostic res70: LRTI
H300.00 Read Tracheobronchitis NOS diagnostic res70: LRTI
H301.00 Read Laryngotracheobronchitis diagnostic res70: LRTI
H30..11 Read Chest infection - unspecified bronchitis diagnostic res70: LRTI
H30..12 Read Recurrent wheezy bronchitis diagnostic res70: LRTI
H302.00 Read Wheezy bronchitis diagnostic res70: LRTI
H30z.00 Read Bronchitis NOS diagnostic res70: LRTI
H34..00 Read Bronchiectasis diagnostic res70: LRTI
H340.00 Read Recurrent bronchiectasis diagnostic res70: LRTI
H341.00 Read Post-infective bronchiectasis diagnostic res70: LRTI
H34z.00 Read Bronchiectasis NOS diagnostic res70: LRTI
H50..00 Read Empyema diagnostic res70: LRTI
H500100 Read Empyema with bronchopleural fistula diagnostic res70: LRTI
H501200 Read Pleural empyema diagnostic res70: LRTI
H501400 Read Purulent pleurisy diagnostic res70: LRTI
H51..00 Read Pleurisy diagnostic res70: LRTI
H510300 Read Acute dry pleurisy diagnostic res70: LRTI
H510900 Read Pneumococcal pleurisy diagnostic res70: LRTI
H583200 Read Eosinophilic bronchitis diagnostic res70: LRTI

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