优蜜传媒

Doctors are prescribing antibiotics for tens of thousands of patients with infections, with little or no consideration of prognosis and the risk of the infection worsening, according to a new study led by University of 优蜜传媒 epidemiologists. 

The study of 15.7 million patient records, funded by the National Institute for Health and Care Research and published in the prestigious Journal of the R, implies there could be scope to prescribe far fewer antibiotics. 

The researchers found the probability of being prescribed antibiotics for a lower respiratory tract or urinary tract infection was unrelated to hospital admission risk. 

And the probability of being prescribed an antibiotic for an upper respiratory tract infection was only weakly related to hospital admission risk. 

The study also showed that patient characteristics such as age and the presence of other health problems were only weakly associated with the probability of being prescribed an antibiotic treatment of common infection. 

The most elderly patients in the sample were 31% less likely than the youngest patients to receive an antibiotic for upper respiratory infections. 

That inevitably means, say the researchers, that because many younger people are being prescribed antibiotics, even though they are often fit enough to recover without them, potentially  leading to resistance. 

Conversely,  many older people may not be able to deal with infections without antibiotics are not  receiving them, with the potential of complication and hospital admissions. 

Patients with combinations of diseases were 7% less likely than people without major health problems  to receive an antibiotic for upper respiratory infections. 

Lead authors are  Professor Tjeerd van Staa and Dr Ali Fahmi, from The University of 优蜜传媒. 

Professor Tjeerd van Staa said: 鈥淎ntibiotics are effective in treating bacterial infections, but they carry the risks of antimicrobial resistance (AMR) and loss of effectiveness when used inappropriately. 

鈥淭hat is why AMR to antibiotics has been recognised as one of the biggest threats to global public health. 

鈥淕iven the threat of resistance, there is a need to better target antibiotics in primary care to patients with higher risks of infection-related complications such as sepsis. 

鈥淏ut this study finds that antibiotics for common infections are commonly not prescribed according to complication risk and that suggests there is plenty of scope to do more on reducing antibiotic prescribing.鈥� 

The study also showed that the probability of being prescribed an antibiotic for lower respiratory infections was even more unrelated to complication risk during the pandemic, however they were only minor changes for urinary tract infections. 

The research team accessed anonymised patient-level electronic health records of primary care data from The Phoenix Partnership (TPP) through OpenSAFELY, a secure platform for electronic health records in the NHS. 

They included adults registered at general practices in England from January 2019 to March 2023 diagnosed with upper respiratory, lower respiratory and urinary tract infections. 

Patient-specific risks of infection-related hospital admission were estimated for each infection using risk prediction scores for patients who were not prescribed an antibiotic. 

Dr Ali Fahmi added: 鈥淩ather than imposing targets for reducing inappropriate prescribing, we argue that it is far more viable for clinicians to focus on improving risk-based antibiotic prescribing for infections that are less severe and typically self-limiting. 

鈥淧rognosis and harm should explicitly be considered in treatment guidelines, alongside better personalised information for clinicians and patients to support shared decision making.鈥�

鈥淎 Knowledge Support (KSS) led by Professor Tjeerd van Staa, which provides personalised information to clinicians is  now being tested in the North-West England

鈥淲e hope it could provide a workable solution to the problem of untargeted antibiotic prescribing.鈥�

Antibiotics for common infections in primary care before, during and after the COVID-19 pandemic: cohort study of extent of prescribing based on risks of infection-related hospital admissions  is published in  DOI: 10.1177/01410768251328997