Reassurance for GPs that prescribing fewer antibiotics to patients with RTIs won’t cause complications
GPs can be reassured that prescribing fewer antibiotics to patients with respiratory tract infections won’t cause complications from the untreated infections to skyrocket, a UK study suggests.
After analysing 4.5 million patient records from 610 general practices, the researchers found rates of meningitis, mastoiditis, empyema, intracranial abscess and Lemierre’s syndrome were no different among the lowest prescribing practices compared to the highest prescribing ones.
However, they did find very small increases in the rates of pneumonia and peritonsillar abscess.
The researchers estimated that if a general practice with 7,000 patients reduced its antibiotic prescribing to patients with RTIs by 10%, there might only be one extra case of pneumonia per year and one extra case of peritonsillar abscess every decade.
“Our paper should reassure GPs and patients that rare bacterial complications of respiratory infections are indeed rare,” study author Dr Mark Ashworth, a GP and researcher at King’s College London, said.
“Fortunately, if there are any signs of a complication, the GP can quickly step in and offer an appropriate antibiotic.”
Meanwhile, every patient who avoids antibiotics also avoids the potential for side effects such as rashes, vomiting and diarrhoea, which may trouble one in 10 patients.
GPs might also get the benefits of fewer patients visiting for RTIs, the authors said, referring to studies linking practices with higher rates of antibiotic prescribing to an increased number of consultations.
A 10% decrease in antibiotic prescribing would be the equivalent of around 2000 fewer antibiotics prescribed over a 10-year period, the authors noted.
In the UK, around half of all patients with RTIs were given antibiotics in primary care, contrary to recommendations.
Similar patterns of prescribing are echoed here, according to figures released last month by the Australian Commission on Safety and Quality in Health Care.
Nevertheless, GPs should still consider antibiotics in the very young and old, and patients with comorbidities or signs of serious illness, the authors warned.
BMJ; online 4 July
