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Antibiotic treatment failure in four common infections in UK primary care 1991-2012: longitudinal analysis

Currie, Craig J., Berni, Ellen, Jenkins-Jones, Sara, Poole, Chris D., Ouwens, Mario, Driessen, Stefan, de Voogd, Hanka, Butler, Christopher C. and Morgan, Christopher LI 2014. Antibiotic treatment failure in four common infections in UK primary care 1991-2012: longitudinal analysis. BMJ 349 , g5493. 10.1136/bmj.g5493

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Abstract

Objective: To characterise failure of antibiotic treatment in primary care in the United Kingdom in four common infection classes from 1991 to 2012. Design: Longitudinal analysis of failure rates for first line antibiotic monotherapies associated with diagnoses for upper and lower respiratory tract infections, skin and soft tissue infections, and acute otitis media. Setting: Routine primary care data from the UK Clinical Practice Research Datalink (CPRD). Main outcome measures: Adjusted rates of treatment failure defined by standardised criteria and indexed to year 1 (1991=100). Results: From 58 million antibiotic prescriptions in CPRD, we analysed 10 967 607 monotherapy episodes for the four indications: 4 236 574 (38.6%) for upper respiratory tract infections; 3 148 947 (28.7%) for lower respiratory tract infections; 2 568 230 (23.4%) for skin and soft tissue infections; and 1 013 856 (9.2%) for acute otitis media. In 1991, the overall failure rate was 13.9% (12.0% for upper respiratory tract infections; 16.9% for lower respiratory tract infections; 12.8% for skin and soft tissue infections; and 13.9% for acute otitis media). By 2012, the overall failure rate was 15.4%, representing an increase of 12% compared with 1991 (adjusted value indexed to first year (1991) 112, 95% confidence interval 112 to 113). The highest rate was seen in lower respiratory tract infections (135, 134 to 136). While failure rates were below 20% for most commonly prescribed antibiotics (amoxicillin, phenoxymethylpenicillin (penicillin-V), and flucloxacillin), notable increases were seen for trimethoprim in the treatment of upper respiratory tract infections (from 29.2% in 1991-95 to 70.1% in 2008-12) and for ciprofloxacin (from 22.3% in 1991-95 to 30.8% in 2008-12) and cefalexin (from 22.0% in 1991-95 to 30.8% in 2008-12) in the treatment of lower respiratory tract infections. Failure rates for broad spectrum penicillins, macrolides, and flucloxacillin remained largely stable. Conclusions: From 1991 to 2012, more than one in 10 first line antibiotic monotherapies for the selected infections were associated with treatment failure. Overall failure rates increased by 12% over this period, with most of the increase occurring in more recent years, when antibiotic prescribing in primary care plateaued and then increased.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Systems Immunity Research Institute (SIURI)
Subjects: R Medicine > R Medicine (General)
Publisher: BMJ Publishing Group
ISSN: 0959-8138
Date of Acceptance: 27 August 2014
Last Modified: 21 May 2020 15:45
URI: http://orca-mwe.cf.ac.uk/id/eprint/79499

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