United Kingdom primary care study finds overly long antibiotic courses

Pills held in a hand

Pills held in a hand

In an accompanying editorial, Alistair Hay, MD, a general practitioner and professor at the University of Bristol Medical School, says the findings indicate that prescribers need to familiarize themselves with national guidelines for managing common infections, many of which have been updated in recent years and in some cases recommend shorter treatments than earlier guidelines.

The authors of the study say the findings highlight poor adherence to guidelines on treatment duration, an important aspect of antibiotic stewardship in primary care that may get overlooked in the focus on whether the initial prescribing decision is appropriate.

THURSDAY, Feb. 28, 2019 (HealthDay News) - For older adults with a urinary tract infection (UTI), antibiotic treatment should begin immediately to prevent serious complications, a new British study finds.

The researchers then compared outcomes for the 87% of patients who were prescribed immediate antibiotics (on the day of diagnosis), the 6% who had deferred antibiotics (prescription within seven days), and the 7% who had no antibiotics (no record of a prescription within seven days).

Such a decline in antibiotic use, however, may harm vulnerable older patients who are already more likely to develop UTI-related complications, and there is a lack of good evidence about the treatment of UTIs in primary care.

The research also revealed that more than 1 million days' worth of antibiotics use for respiratory tract indications could be cut if guidelines were followed correctly. The risk of death over the same time period among patients who had their antibiotic prescription delayed showed a slight increase (16 per cent), while patients who received no antibiotics had over double the risk.

On average, for every 37 patients not given antibiotics and for every 51 patients with delayed antibiotic treatment, one case of sepsis would occur that would not have occurred with immediate antibiotic treatment, the study authors said.

The researchers also found that hospital admission rates were 27 percent among patients with no and delayed prescriptions, compared with 15 percent among those with immediate prescriptions.

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Older men, especially those aged over 85 years, and those living in more deprived areas were most at risk.

Delaying or withholding antibiotics in this age group can increase the risk of bloodstream infection (sepsis) and death, researchers reported February 27 in the BMJ.

Overuse of antibiotics adds to increased antibiotic resistance levels, and puts patients at risk of side effects, they say.

Lead author Dr Myriam Gharbi, from Imperial's School of Public Health, said: "Current national guidelines for Global Positioning System recommend they should ask patients about the severity of their symptoms, discuss possible self-care, such as drinking plenty of water to avoid dehydration and taking paracetamol or ibuprofen for pain relief and consider a back-up antibiotic prescription to be used if symptoms worsen or have not improved after 48 hours. However, our research suggests antibiotics should not be delayed in elderly patients".

Scientists also studied data from 157, 264 patients aged 65 or above diagnosed with a UTI or suspected UTI to help clarify when antibiotics should be prescribed.

The average age of participants was 77 years, most (79%) cases were female, and follow-up was for 60 days after diagnosis.

And although fewer prescriptions exceeded recommended durations for non-respiratory tract conditions, still more than half (54.6%) of the antibiotic prescriptions for acute cystitis among women were for longer than recommended.

"These studies are to be welcomed as important new evidence to inform antibiotic prescribing policies. This work will help doctors target antibiotic use more effectively and improve patient wellbeing".

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