A new study of general practices in England found that repeat within-episode antibiotic use accounts for a significant proportion of all antibiotics prescribed for respiratory tract infections (RTIs), researchers reported late last week in the Journal of Infection.
Repeat within-episode antibiotic prescribing occurs when a patient who has received an initial prescription receives a repeat prescription because of persisting symptoms. While 54% of RTI consultations in UK primary care result in an antibiotic prescription, and RTI patients frequently reconsult their general practitioner because of ongoing symptoms, data on repeat within-episode antibiotic prescribing for RTIs are lacking. To assess the magnitude of the practice and associated factors, a team of English and Dutch researchers conducted a population-based cohort study among 530 samples from English general practitioners (GPs).
The researchers identified 905,964 RTI episodes with at least one antibiotic prescription from March 2018 through February 2022. Nearly half (48.6%) involved adults consulting their GP for an upper RTI. In children, 89.9% of episodes were related to upper RTI. The overall proportion of within-episode repeat prescriptions was 12.7%. In adults, within-episode repeat prescribing rates were higher for lower RTI (19.9%) than for upper RTI (10.5%). In children, the rates were similar for lower RTI (10.5%) and upper RTI (10.0%). Most episodes occurred more than 7 days after the initial prescription.
Frequent RTI-related GP visits and prior within-RTI-episode repeat antibiotic prescriptions were the main factors associated with repeat prescriptions in both adults and children, irrespective of RTI type. Other factors included age less than 2 years or more than 65 years. Among those aged 2 to 64 years, allergic rhinitis, chronic obstructive pulmonary disease, and oral corticosteroids were associated with repeat prescriptions.
A potential 'quick win' for stewardship
The study authors say clinicians should emphasize to patients that while the natural course of most RTIs is considerably longer than a single course of antibiotics, a single course is likely to be microbiologically adequate. They suggest the practice should be a target for antimicrobial stewardship interventions.
"Reducing within-episode antibiotic prescriptions could represent a 'quick win' for antimicrobial stewardship teams," they wrote.