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Antibiotic prescribing and outcomes of lower respiratory tract infection in UK primary care

Antibiotic prescribing and outcomes of lower respiratory tract infection in UK primary care
Antibiotic prescribing and outcomes of lower respiratory tract infection in UK primary care
Background
Lower respiratory tract infection (LRTI) is common in the community, and may result in hospitalization or death. This observational study aimed to investigate the role of antibiotics in the management of LRTI in UK primary care.
Methods
Patients receiving a first diagnosis of LRTI during 2004 and satisfying inclusion and data quality criteria were identified in the General Practice Research Database. Factors associated with respiratory infection-related admissions and death in the 3 months following initial diagnosis were identified using Cox proportional hazards regression.
Results
Antibiotic prescribing on the day of diagnosis was associated with a decreased rate of respiratory infection-related admission (hazard ratio: 0.73; 95% confidence interval: 0.58–0.92), while antibiotic prescribing in the previous 7 days (1.92; 1.24–2.96) and prior referral or hospitalization (1.48; 1.20–1.83) were associated with an increased risk of admission. Female sex (0.73; 0.64–0.84), allergic rhinitis (0.48; 0.27–0.83), influenza vaccination (0.75; 0.65–0.87), prior inhaled corticosteroid use (0.63; 0.52–0.76) and antibiotic prescription on the day of diagnosis (0.31; 0.26–0.37) were associated with decreased respiratory infection-related mortality, while a Charlson comorbidity index of > 2 (2.24; 1.72–2.92), antibiotic prescription in the previous 7 days (1.56; 1.20–2.03) and frequent consultation (1.62; 1.09–2.40) were associated with increased mortality.
Conclusions
Antibiotic prescribing on the day of LRTI diagnosis was associated with reductions in admissions and mortality related to respiratory infection. Antibiotics may help to prevent adverse outcomes for some patients with LRTI.


0012-3692
1163-1172
Winchester, C.C.
d0d4fb28-e61f-4b77-be43-5e1c9994e06a
Macfarlane, T.
f962fee6-79c3-4b75-a49b-4f22e12da53a
Thomas, M
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Price, D.B.
8efb35a7-5945-45ea-92d1-caa046a37224
Winchester, C.C.
d0d4fb28-e61f-4b77-be43-5e1c9994e06a
Macfarlane, T.
f962fee6-79c3-4b75-a49b-4f22e12da53a
Thomas, M
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Price, D.B.
8efb35a7-5945-45ea-92d1-caa046a37224

Winchester, C.C., Macfarlane, T., Thomas, M and Price, D.B. (2009) Antibiotic prescribing and outcomes of lower respiratory tract infection in UK primary care. Chest, 135 (5), 1163-1172. (doi:10.1378/chest.07-2940). (PMID:19420194)

Record type: Article

Abstract

Background
Lower respiratory tract infection (LRTI) is common in the community, and may result in hospitalization or death. This observational study aimed to investigate the role of antibiotics in the management of LRTI in UK primary care.
Methods
Patients receiving a first diagnosis of LRTI during 2004 and satisfying inclusion and data quality criteria were identified in the General Practice Research Database. Factors associated with respiratory infection-related admissions and death in the 3 months following initial diagnosis were identified using Cox proportional hazards regression.
Results
Antibiotic prescribing on the day of diagnosis was associated with a decreased rate of respiratory infection-related admission (hazard ratio: 0.73; 95% confidence interval: 0.58–0.92), while antibiotic prescribing in the previous 7 days (1.92; 1.24–2.96) and prior referral or hospitalization (1.48; 1.20–1.83) were associated with an increased risk of admission. Female sex (0.73; 0.64–0.84), allergic rhinitis (0.48; 0.27–0.83), influenza vaccination (0.75; 0.65–0.87), prior inhaled corticosteroid use (0.63; 0.52–0.76) and antibiotic prescription on the day of diagnosis (0.31; 0.26–0.37) were associated with decreased respiratory infection-related mortality, while a Charlson comorbidity index of > 2 (2.24; 1.72–2.92), antibiotic prescription in the previous 7 days (1.56; 1.20–2.03) and frequent consultation (1.62; 1.09–2.40) were associated with increased mortality.
Conclusions
Antibiotic prescribing on the day of LRTI diagnosis was associated with reductions in admissions and mortality related to respiratory infection. Antibiotics may help to prevent adverse outcomes for some patients with LRTI.


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More information

Published date: May 2009
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 337298
URI: https://eprints.soton.ac.uk/id/eprint/337298
ISSN: 0012-3692
PURE UUID: 4fd19034-c2f2-4ac5-9b6a-3f708371f1f2

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Date deposited: 23 Apr 2012 14:21
Last modified: 16 Jul 2019 22:07

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