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Antibiotics for Respiratory Tract Infections

In this video Michael discusses the latest data surrounding each of these and challenges common held beliefs of ABX in respiratory tract infections
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So bearing all that in mind, why are we prescribing so much for respiratory infections? [coughs]. And there are several drivers of that. Maybe we’re thinking that we’ll provide good relief of symptoms with a prescription. Maybe it’s worry about complications or more serious illness. [coughs]. And maybe it’s a response to patient pressure, or a combination of those things. So I’m going to deal with each of those in turn, firstly thinking about relief of symptoms. And this is data lifted from the NICE guidelines on treatment of respiratory tract infection. And the circle there is around the expected average benefit for a course of antibiotics in each of those illnesses.
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So you can see the best you can hope for is a day’s reduction in symptom duration, between 12 and 24 hours for all of those conditions, otitis media, sore throat, sinusitis, and bronchitis. So not much evidence of substantial relief from symptoms then with antibiotics. What about complications? This is data which has been published earlier this year from routine data comparing high prescribing and low prescribing practices, and looking for an association between prescribing rates at practice level and complication rates from infection. And there was no association between the risk of mastoiditis, empyema, meningitis, or intracranial abscess and prescribing rates. There was an association though, between prescribing rates and the risk of pneumonia and peritonsillar abscess.
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So we went on to try and put numbers on that. And so if a practice of 7,000 reduced its prescribing of antibiotics by about 10%, then they might see one additional case of pneumonia in a year and one additional peritonsillar abscess every 10 years. So although there is an association between antibiotic prescribing, the magnitude of that effect is small. Peterson looked at this some years ago at an individual patient level and estimated that to prevent a complication, you needed to treat around 4,000 people.
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The complications for pneumonia following lower respiratory tract infection was more common though, with a number needed to treat of only 39 in the over 65-year-old group, with a number needed to treat of around 100 in the under 65s. And this is reflected in the NICE guidance, where there’s a rule for treating people with lower respiratory tract infection with some risk factors. Finally, just to look at patient demand, this was looked at some years ago. And by and large, GPs overestimate patient demand. It can be a significant problem. And 30% to 40% of people do come with the intention of getting a prescription for antibiotics.
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But people also want information about how to relieve their symptoms, what the diagnosis is, what the natural history is likely to be, and reassurance about what the future holds for them. So you do need to address the demand. And you need to think about what else patients might want to hear.
In this video Michael discusses the latest data surrounding each of these antibiotics and challenges commonly-held beliefs.
In most cases antibiotics will be prescribed for respiratory tract infections due to one of the reasons below:
  • Symptom relief
  • Avoid complications
  • Patient pressure
Michael will go on to explain why clinicians overestimating patient demand is a significant problem and how this ignores patient’s holistic care needs.
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TARGET Antibiotics – Prescribing in Primary Care

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