Antibiotic prescribing and admissions with major suppurative complications of respiratory tract infections: a data linkage study.
BACKGROUND
Systematic reviews of antibiotic treatment of common acute respiratory tract infections (RTIs) suggest modest symptomatic benefit, but provide limited evidence that prescribing prevents complications.


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


METHODS
Data linkage study.


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


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


RESULTS
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 (-3.55 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 10,000 patients could possibly prevent one admission for either mastoiditis or quinsy.


CONCLUSIONS
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.
Little
Paul
P
Community Clinical Sciences (Primary Medical Care Group), University of Southampton, Aldermoor Health Centre, Aldermoor Close. psl3@soton.ac.uk
Watson
Louise
L
Morgan
Stephen
S
Williamson
Ian
I
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D010406:Penicillins / Q000627:therapeutic use*; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy*
D010406:Penicillins