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Antibiotic prescribing

01 March 2011


Patients across Europe with coughs and lower respiratory tract infections (LRTI) are not prescribed antibiotics in-line with key EU professional guidelines, a University research study has discovered.

Experts in Primary Care and Public Health from the School of Medicine, led by Professor Chris Butler, examined data from 3402 patients recruited by 387 practitioners from primary care research networks across Europe to explore the extent to which the level of antibiotic prescribing and actual antibiotic choice for treating acute cough were in-line with guidelines established by the European Respiratory Society-European Society of Clinical Microbiology and Infectious Diseases (ERS-ESCMID).

"Acute cough/LRTI is one of the commonest reasons for prescribing antibiotics. What our study has found is a wide variation in whether antibiotics are prescribed or not and in which antibiotics are chosen by doctors," according to Professor Butler.

"Fewer antibiotics should be prescribed for LRTI, and first line, narrower spectrum agents should be chosen more often," he added.

The study found that just over half the patients (1776, 52.7%) were prescribed an antibiotic, but clinicians could have justified antibiotic prescriptions for many more by a literal reading of the guidelines.

An estimated 70.8% of the patients could have been considered by the guidelines to have suspected or definite pneumonia; clinicians, however, reported pneumonia as their working diagnosis in only 4.3% of cases.

With stricter definitions of suspected or definite pneumonia, only 3.1% to 27.8% of patients would satisfy the criteria, and an antibiotic would be justified in only 8.0% to 29.7% of cases. Among patients prescribed antibiotics, only 42.8% were prescribed the first choice antibiotics (tetracycline or amoxicillin); 13.6% received an antibiotic not recommended by the guidelines.

As a result of the study, Professor Butler is now calling for better evidence to support guidelines to help doctors make the right antibiotic prescribing choices.

"We suspect that the guideline producers were limited by the paucity of research evidence to support their recommendations for managing lower respiratory tract infections in primary care.

"Definitions of the clinical entities covered were therefore not very specific. This allowed for a wide range of interpretations of the guidelines.

"Guidelines need to be supported by a well-developed evidence base to allow them to be quite specific. We need more evidence from primary care about which patients can safely be managed without antibiotics. Also, we need clearer definitions about clinical entities and which subgroups of patients are most likely to benefit from early antibiotic intervention and ongoing monitoring," Professor Butler added.

The study was published in the European Respiratory Journal. A copy of the paper is available at:

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