Risk of unintended consequences from lower antibiotic prescribing for respiratory tract infections in primary care

Objectives: About 60% of antibiotic prescribing in primary care is for respiratory tract infections (RTIs), some of which is likely unnecessary. There is limited evidence on the association between reduced antibiotic prescribing and adverse events. We aimed to identify associations between practice-level prescribing rates for RTIs in general practice, and patient-level adverse outcomes.<br /> Methods: We included 1471 English General Practitioner (GP) practices, linked to hospital admissions in England, from the Clinical Practice Research Datalink for 2005 to 2019. Outcomes were hospitalisations, RTIrelated re-consultations and additional antibiotic prescriptions, adjusted for practice level case-mix prescribing.<br /> Results: Prescribing rates for practices falling within the lowest and highest prescribing quintiles were 52 and 139 prescriptions per 1000 RTI-related consultations. Patients from practices in the lowest prescribing quintile did not have significantly higher risk of hospitalisation, adjusted odds ratio 0<middle dot>99 (95% CI 0<middle dot>96 to 1<middle dot>02). Re-consultations within 30 days were significantly higher for the lowest prescribing practices, adjusted odds ratio 1<middle dot>209 (1<middle dot>206 to 1<middle dot>212). Additional antibiotic prescriptions and subsequent prescriptions upon re-consultation were significantly lower for the lowest prescribing practices, adjusted odds ratio 0<middle dot>317 (0<middle dot>314 to 0<middle dot>321) and 0<middle dot>706 (0<middle dot>699 to 0<middle dot>712), respectively.<br /> Conclusions: Our results contribute to evidence on the safety of reduced antibiotic prescribing for RTIs in primary care. Results suggest that for the majority of practices, further reductions in RTI-related antibiotic prescribing should be possible without an increase in hospitalisation for pneumonia.<br /> Crown Copyright (c) 2024 Published by Elsevier Ltd on behalf of The British Infection Association. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).