title: Antibiotic prescribing for chronic skin wounds in primary care.
abstract: The aim of this study was to describe and quantify systemic antibiotic prescribing for patients with chronic skin wounds presenting at the primary care, nonspecialist setting. Data for 1 year were extracted from a general practice morbidity database comprising approximately 185,000 patients attending family medical practitioners in Wales. Patients with chronic wounds (PCW) were identified using Read Codes and compared with nonwound patients who were randomly selected after matching for age-band, sex, and general practice. PCW received a significantly greater number of antibiotic courses than nonwound patients (p<0.001). This increased level of prescribing was evident for flucloxacillin, co-amoxiclav, cefaclor, cefalexin, erythromycin, trimethoprim, metronidazole, and ciprofloxacin (p<0.01 for all). While PCW also had a significantly higher prevalence of diabetes (16.5% compared with 6.6%, p<0.001), and attended at general practice significantly more frequently than nonwound patients (median (interquartile range) of 25 (17-40) visits per year compared with 12 (4-20), p<0.001), importantly, exclusion of diabetic patients and analysis of the proportion of visits on which patients received antibiotics did not affect the significance of the difference in antibiotic consumption. These data show a strong association between occurrence of chronic wounds and prescribing of antibiotics in primary health care, and wide variation in the type and duration of antibiotic therapy for chronic wounds. Further work is now indicated to rationalize this prescribing and determine the role that this exposure to antibiotics plays in the prevalence of antibiotic resistance in this at-risk elderly population.
authors.affiliation: Wound Biology Group and Department of Oral Surgery, Medicine and Pathology, Wales College of Medicine, Cardiff University, Cardiff, Wales, United Kingdom. Howell-JonesRS@cf.ac.uk
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Howell-Jones
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Price
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Howard
authors.forename: David W
authors.initials: DW
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016022:Case-Control Studies; D002908:Chronic Disease; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012883:Skin Ulcer / Q000188:drug therapy* / Q000209:etiology; D006113:United Kingdom
chemical_list: D000900:Anti-Bacterial Agents