12 The categories used for analysis may have combined several different entities, for example, prescribing may be more frequent for cases coded as ‘bronchitis’ than for ‘cough’. Prescribing for sinusitis was generally
high, even at lower prescribing practices. We have not analysed selleck compound practice characteristics as possible predictors of antibiotic prescribing, but such analyses typically only explain a small proportion of the variation between practices.16 The results suggest that most practices commonly prescribe antibiotics unnecessarily. Patient characteristics such as age,17 gender, comorbidity, smoking status or deprivation category might also be associated with prescribing decisions. Nevertheless, these results suggest that many patients may be prescribed antibiotics unnecessarily. Reducing antibiotic prescribing may lead to lower consultation rates for RTI.18 The present study did not include children who represent some of the highest users of antibiotic prescriptions17 but children will be included in a planned cluster randomised trial in CPRD to start in 2015. The present results have implications for communications with the public as well as for practice prescribing policies. Respiratory infections in this age group are both self-limiting and carry a low risk of complications, moreover the impact of antibiotics
on symptom severity and duration is at best marginal. Respiratory infections may be better managed through patient self-care rather than primary care consultation. The high rates of antibiotic prescribing reported by this study indicate a need to shift the entire distribution for antibiotic prescribing to lower levels, since there are very few practices that are not prescribing antibiotics to excess, fuelling the development of antibiotic resistance. In addition, there are immediate direct costs from prescribing antibiotics, as well as
risks of drug side effects and the perpetuation of unnecessary consultation patterns. There needs to be an active professional debate concerning an overall level of antibiotic Batimastat utilisation for RTI that might be acceptable, and the size of reduction that individual practices should aim to achieve as a matter of urgency. Supplementary Material Author’s manuscript: Click here to view.(981K, pdf) Reviewer comments: Click here to view.(258K, pdf) Footnotes Contributors: MCG designed, supervised and drafted the paper. LM assisted with draft and conclusions. JC and AD contributed to data analysis. MA, MVM, PL, LY contributed to design, write-up and interpretation of data. TvS and GM contributed to practice recruitment and facilitated access to CPRD. All authors contributed to the paper and approved the final draft. All authors read and approved the final manuscript.