Antibiotic prescribing and admissions with major suppurative complications of respiratory tract infections: a data linkage study

Little, Paul, Watson, Louise, Morgan, Stephen and Williamson, Ian (2002) Antibiotic prescribing and admissions with major suppurative complications of respiratory tract infections: a data linkage study. British Journal of General Practice, 52, (476), 187-193.


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Systematic reviews of antibiotic treatment of common acute respiratory tract infections (RTIs) suggest modest symptomatic benefit, but provide limited evidence that prescribing prevents complications.

To assess the relationship between penicillin prescribing (the most commonly used group of antibiotics for RTIs) and hospital admission with complications.

Design of study:
Data linkage study.

Ninety-six health authorities of England for the year 1997-1998.

Hospital admissions related to RTIs were linked with prescribing analysis and cost (PACT) data.

There was close correlation between items of penicillin use and total antibiotic use (r = 0.96). After controlling for SMR, age, sex, and Townsend score, a one-unit increase in penicillin use (items dispensed per capita) was associated with a reduction in annual incidence per 10 000 of admissions for quinsy (-3.5 admissions, 95% confidence interval [CI] =-6.85 to - 0.26), and mastoiditis (square root of incidence of admissions =-1.05, 95% CI =-1.82 to - 0.27). This does not represent lower referral thresholds among higher prescribers as higher prescribing was associated with more admissions for tonsillectomy and overall admissions. Increasing prescribing by 2000 items of penicillin for a practice of 1000 patients could possibly prevent one admission for either mastoiditis or quinsy.

Higher antibiotic prescribing is associated with significantly fewer admissions with major complications. However, the overall size of the effect is modest and it is difficult to advocate an overall increase in prescribing to prevent complications. Future research should concentrate on finding better methods of targeting antibiotics to individuals at risk of poor outcome.

Item Type: Article
ISSNs: 0960-1643 (print)
Related URLs:
Keywords: antibiotics, prescribing, respiratory tract infections, hospital admission rate, complications
Subjects: R Medicine > RM Therapeutics. Pharmacology
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions : University Structure - Pre August 2011 > School of Medicine > Community Clinical Sciences
ePrint ID: 24402
Accepted Date and Publication Date:
March 2002Published
Date Deposited: 30 Mar 2006
Last Modified: 31 Mar 2016 11:45

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