Researchers from the United Kingdom reported that practices adopting a policy to decrease antibiotic prescribing for respiratory tract infections (RTIs) may expect a slight increase in the incidence of treatable pneumonia and peritonsillar abscess. 

RTIs are commonly treated with antibiotics, however conditions such as acute bronchitis and otitis media are often self-limiting and typically improve without the need for these drugs. In this study, the authors aimed to discover whether reducing antibiotic prescribing increased the risk of RTI complications. Study authors performed a cohort study to determine whether the incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre’s syndrome was higher in general practices that prescribed less antibiotics for self-limiting RTIs. A total of 610 general practices from the United Kingdom Clinical Practice Research Datalink including registered patients with 45.5 million person years of follow-up from 2005–2014 were evaluated for standardized proportion of RTI consultations with antibiotics prescribed for each practice and the rate of antibiotic prescriptions for RTIs per 1,000 registered patients. 

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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 during the follow-up years. Also during this time, new occurrences of meningitis, mastoiditis, and peritonsillar abscess reduced annually 5.3%, 4.6%, and 1.0%, respectively, whereas new episodes of pneumonia increased by 0.4%. The adjusted relative risk increases for a 10% reduction in antibiotic prescribing were 12.8% (955 CI: 7.8%–17.5%; P<0.001) for pneumonia and 9.9% (95% CI: 5.6%–14.05%; P<0.001) for peritonsillar abscess. 

A practice with an average of 7,000 patients that reduces the proportion of RTI consultations with antibiotics prescriptions by 10%, may see 1.1 times more cases of pneumonia each year (95% CI: 0.6–1.5) and 0.9 times more cases of peritonsillar abscess (95% CI: 0.5–1.3) each decade. No increase was likely for mastoiditis, empyema, meningitis, intracranial abscess, or Lemierre’s syndrome. Findings supported that even a substantial decrease in antibiotic prescribing was expected to be associated with a small increase in numbers of cases observed overall but caution may be required for patients at higher risk of pneumonia. 

Professor Del Mar added that antibiotics should be conserved in primary care so that resistance is minimized and possibly even reversed.

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