Understanding flucloxacillin prescribing trends and treatment non-response in UK primary care: a Clinical Practice Research Datalink (CPRD) study

被引:20
作者
Francis, Nick A. [1 ]
Hood, Kerenza [2 ]
Lyons, Ronan [3 ]
Butler, Christopher C. [4 ]
机构
[1] Cardiff Univ, Sch Med, Div Populat Med, 3rd Floor,Heath Pk, Cardiff CF14 4YS, S Glam, Wales
[2] Cardiff Univ, Coll Biomed & Life Sci, Ctr Trials Res, 7th Floor,Heath Pk, Cardiff CF14 4YS, S Glam, Wales
[3] Swansea Univ, Sch Med, Farr Inst, Singleton Pk, Swansea SA2 8PP, W Glam, Wales
[4] Univ Oxford, Nuffield Dept Primary Care Hlth Sci, Radcliffe Observ Quarter, New Radcliffe House,Woodstock Rd, Oxford OX2 6NW, England
基金
英国工程与自然科学研究理事会; 英国经济与社会研究理事会;
关键词
RESISTANT STAPHYLOCOCCUS-AUREUS; LOWER-LIMB CELLULITIS;
D O I
10.1093/jac/dkw084
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Objectives: The volume of prescribed antibiotics is associated with antimicrobial resistance and, unlike most other antibiotic classes, flucloxacillin prescribing has increased. We aimed to describe UK primary care flucloxacillin prescribing and factors associated with subsequent antibiotic prescribing as a proxy for non-response. Patients and methods: Clinical Practice Research Datalink patients with acute prescriptions for oral flucloxacillin between January 2004 and December 2013, prescription details, associated Read codes and patient demographics were identified. Monthly prescribing rates were plotted and logistic regression identified factors associated with having a subsequent antibiotic prescription within 28 days. Results: 3031179 acute prescriptions for 1667431 patients were included. Average monthly prescription rates increased from 4.74 prescriptions per 1000 patient-months in 2004 to 5.74 (increase of 21.1%) in 2013. The highest prescribing rates and the largest increases in rates were seen in older adults (70+ years), but the overall increase in prescribing was not accounted for by an ageing population. Prescribing 500 mg tablets/capsules rather than 250 mg became more common. Children were frequently prescribed low doses and small volumes (5 day course) and prescribing declined for children, including for impetigo. Only 4.2% of new prescriptions involved co-prescription of another antibiotic. Age (<5 and >= 60 years), diagnosis of 'cellulitis or abscess' or no associated code, and 500 mg dose were associated with a subsequent antibiotic prescription, which occurred after 17.6% of first prescriptions. Conclusions: There is a need to understand better the reasons for increased prescribing of flucloxacillin in primary care, optimal dosing (and the need to co-prescribe other antibiotics) and the reasons why one in five patients are prescribed a further antibiotic within 4 weeks.
引用
收藏
页码:2037 / 2046
页数:10
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