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 the primary care setting in the United Kingdom.


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 hospital admissions and death in the 3 months following the 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 hospital admission (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.58 to 0.92), while antibiotic prescribing in the previous 7 days (HR, 1.92; 95% CI, 1.24 to 2.96) and prior referral or hospitalization (HR, 1.48; 95% CI, 1.20 to 1.83) were associated with an increased risk of hospital admission. Female sex (HR, 0.73; 95% CI, 0.64 to 0.84), allergic rhinitis (HR, 0.48; 95% CI, 0.27 to 0.83), influenza vaccination (HR, 0.75; 95% CI, 0.65 to 0.87), prior inhaled corticosteroid use (HR, 0.63; 95% CI, 0.52 to 0.76), and antibiotic prescription on the day of diagnosis (HR, 0.31; 95% CI, 0.26 to 0.37) were associated with decreased respiratory infection-related mortality, while a Charlson comorbidity index of >or= 2 (HR, 2.24; 95% CI, 1.72 to 2.92), antibiotic prescription in the previous 7 days (HR, 1.56; 95% CI, 1.20 to 2.03), and frequent consultation (HR, 1.62; 95% CI, 1.09 to 2.40) were associated with increased mortality.


CONCLUSIONS
Antibiotic prescribing on the day of LRTI diagnosis was associated with reductions in hospital admissions and mortality related to respiratory infection. Antibiotics may help to prevent adverse outcomes for some patients with LRTI.
Winchester
Christopher C
CC
Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen, UK. Electronic address: c.winchester@abdn.ac.uk.
Macfarlane
Tatiana V
TV
Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen, UK.
Thomas
Mike
M
Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen, UK.
Price
David
D
Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen, UK.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007223:Infant; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000517:prevention & control; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011379:Prognosis; D016016:Proportional Hazards Models; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D006113:United Kingdom; D055815:Young Adult
D000900:Anti-Bacterial Agents