Significant proportion of RTIs given more than one antibiotic course

Almost one in five adults and one in ten children receive a second course of antibiotics for the same respiratory tract infection, researchers have found.

Analysis of GP records of more than 900,000 cases of respiratory tract infection across 530 practices in England also found that in half the cases of repeat antibiotic prescribing, the same antibiotic class was used.

Writing in the Journal of Infection, the researchers said reducing ‘within-episode’ repeat antibiotic prescribing could be a ‘quick win’ for improving antibiotic stewardship.

Among the cases looked at, which all had at least one antibiotic prescribed, 19.9% of adults with a lower respiratory tract infection had at least one other antibiotic prescription within 28 days as did 10.5% for an upper respiratory tract infection.

In children, the researchers found a repeat antibiotic prescribing rate of around 10% regardless of the type of respiratory tract infection.

Most repeat prescriptions occurred around 10 days after the initial antibiotic was given and 48.3% were the from the same antibiotic class, the researchers found.

Among the factors associated with repeat prescribing for the same illness, were frequent visits to the GP for respiratory tract infections and previous within-episode antibiotic prescribing for the condition.

Children under the age of two years and adults over 65 years were also more likely to have repeat antibiotics for the same episode, the researchers found.

Primary care guidelines recommend a no or delayed antibiotic prescribing strategy in the vast majority of patients with respiratory tract infection, yet 54% of consultations in the UK lead to an antibiotic prescription, the researchers said.

Respiratory tract infections also account for 60% of antibiotic prescribing in primary care globally and have been identified as one of the key drivers of antimicrobial resistance, they added.

This is despite previous research showing that for most child and adult patients with chest infections, particularly those without chronic lung disease, even a single antibiotic course is unlikely to have clinical benefit, they noted.

Study author Professor Alastair Hay, a GP and professor of primary care at the University of Bristol, said: ‘It seems implausible that repeat antibiotic courses will have any benefit given that there is clear evidence that children and adults without chronic lung disease do not benefit from a first course of antibiotics, and that NICE recommends five-day antibiotic courses for the severest lower respiratory tract infections, such as pneumonia.’

Co-author Arief Lalmohamed, senior lecturer at University Medical Center, Utrecht, said their research showed repeat within-episode antibiotic use accounts for a ‘significant proportion’ of all antibiotics prescribed for respiratory tract infections.

‘In light of our findings, it’s clear that antimicrobial stewardship interventions must extend beyond initial antibiotic prescriptions to address within-episode repeats.’

This article first appeared in our sister title Pulse.