Short Attention Span Summary
Less is more
If providers prescribe fewer antibiotics to patients with respiratory tract infection, does this cause harm? It may slightly increase cases of pneumonia and peritonsillar abscess (PTA), but doesn’t result in an increase in, “mastoiditis, empyema, bacterial meningitis, intracranial abscess, or Lemierre’s syndrome.”
Hold the C. diff
Although cases of PTA and pneumonia may have slightly increased, the study didn’t mention if there was a corresponding decrease in antibiotic complications, such as C. difficile colitis or allergic reaction. But I’ll bet there was.
If you’re pretty sure your patient does not have a bacterial respiratory infection, it’s safe to withhold antibiotics. Journal Watch has a good free blurb on this.
BMJ. 2016 Jul 4;354:i3410. doi: 10.1136/bmj.i3410.
1Department of Primary Care and Public Health Sciences, King’s College London, Guy’s Campus, London SE1 1UL, UK firstname.lastname@example.org.
2Academic Unit for Primary Care and Population Sciences, University of Southampton, Southampton, UK.
3Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
4The Health Centre, Bicester, Oxford, UK.
5Department of Primary Care and Public Health Sciences, King’s College London, Guy’s Campus, London SE1 1UL, UK.
To determine whether the incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre’s syndrome is higher in general practices that prescribe fewer antibiotics for self limiting respiratory tract infections (RTIs).
610 UK general practices from the UK Clinical Practice Research Datalink.
Registered patients with 45.5 million person years of follow-up from 2005 to 2014.
Standardised proportion of RTI consultations with antibiotics prescribed for each general practice, and rate of antibiotic prescriptions for RTIs per 1000 registered patients.
MAIN OUTCOME MEASURES:
Incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre’s syndrome, adjusting for age group, sex, region, deprivation fifth, RTI consultation rate, and general practice.
From 2005 to 2014 the proportion of RTI consultations with antibiotics prescribed decreased from 53.9% to 50.5% in men and from 54.5% to 51.5% in women. From 2005 to 2014, new episodes of meningitis, mastoiditis, and peritonsillar abscess decreased annually by 5.3%, 4.6%, and 1.0%, respectively, whereas new episodes of pneumonia increased by 0.4%. Age and sex standardised incidences for pneumonia and peritonsillar abscess were higher for practices in the lowest fourth of antibiotic prescribing compared with the highest fourth. The adjusted relative risk increases for a 10% reduction in antibiotic prescribing were 12.8% (95% confidence interval 7.8% to 17.5%, P<0.001) for pneumonia and 9.9% (5.6% to 14.0%, P<0.001) for peritonsillar abscess. If a general practice with an average list size of 7000 patients reduces the proportion of RTI consultations with antibiotics prescribed by 10%, then it might observe 1.1 (95% confidence interval 0.6 to 1.5) more cases of pneumonia each year and 0.9 (0.5 to 1.3) more cases of peritonsillar abscess each decade. Mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre’s syndrome were similar in frequency at low prescribing and high prescribing practices.
General practices that adopt a policy to reduce antibiotic prescribing for RTIs might expect a slight increase in the incidence of treatable pneumonia and peritonsillar abscess. No increase is likely in mastoiditis, empyema, bacterial meningitis, intracranial abscess, or Lemierre’s syndrome. Even a substantial reduction in antibiotic prescribing was predicted to be associated with only a small increase in numbers of cases observed overall, but caution might be required in subgroups at higher risk of pneumonia.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
PMCID: PMC4933936 Free PMC Article
PMID: 27378578 [PubMed – in process]