title: Cigarette smoking and risk of subsequent use of antibacterials: a follow-up of 365,117 men and women.
abstract: OBJECTIVE
  Antibacterial prescribing is driving antibiotic resistance. We aimed to analyse whether smoking habits are associated with susceptibility to be prescribed antibacterials in primary care and to examine whether patients' smoking habits influence physicians' choice of therapy.
  
  
  METHODS
  Information on smoking habits from health surveys in 1985-99 was related to use of antibacterials 5-25 years later by linkage to the Norwegian Prescription Database. The study population included 365 117 men and women, 40-45 years old. Individuals likely to have chronic obstructive airway disease were excluded. Relative risk (RR) of being dispensed antibacterials for systemic use was calculated for five levels of smoking intensity with never smokers as reference. Adjustments were made for age, education, marital status, household size, body mass index and residence (rural/urban).
  
  
  RESULTS
  Fifty-six percent of the male and 69% of the female never smokers received at least one antibacterial prescription in the whole period, increasing to 68% and 82%, respectively, in heavy smokers (>19 cigarettes/day) (adjusted RR 1.17 and 1.16). The percentage receiving at least one antibacterial prescription every year was 0.5% in male and 1.9% in female never smokers, increasing to 1.1% and 4.0%, respectively, in heavy smokers (adjusted RR 2.07 and 1.89). The proportion of antibacterial users who were prescribed broad-spectrum antibacterials increased with increasing cigarette consumption.
  
  
  CONCLUSIONS
  Smoking habits influenced the usage of antibacterials years later with a dose-response relationship. Prescribers seem to acknowledge smoking as a risk factor for resistant bacteria since broad-spectrum antibacterials are more frequently prescribed to smokers than never smokers.
authors: Department of Pharmacoepidemiology, Norwegian Institute of Public Health, PO Box 4404 Nydalen, NO-0403 Oslo, Norway. hege.salvesen.blix@fhi.no
authors: Hege Salvesen
authors: HS
authors: Blix
authors: Vidar
authors: V
authors: Hjellvik
authors: Irene
authors: I
authors: Litleskare
authors: Marit
authors: M
authors: Rønning
authors: Aage
authors: A
authors: Tverdal
mesh_terms: D000328:Adult; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D016012:Poisson Distribution; D012307:Risk Factors; D012424:Rural Population; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology*; D017211:Treatment Failure; D014505:Urban Population
chemical_list: D000900:Anti-Bacterial Agents