Antibiotic Prescribing and Outcomes of Lower Respiratory Tract Infection in UK Primary Care.
Chest. 2008 Nov 24;
Authors: Winchester CC, Macfarlane T, Thomas M, Price D
Background Lower respiratory tract infection (LRTI) is common in the community, and may result in hospitalization or death. This observational study aimed to investigate the role of antibiotics in the management of LRTI in UK primary care. Methods Patients receiving a first diagnosis of LRTI during 2004 and satisfying inclusion and data quality criteria were identified in the General Practice Research Database. Factors associated with respiratory infection-related admissions and death in the 3 months following initial diagnosis were identified using Cox proportional hazards regression. Results Antibiotic prescribing on the day of diagnosis was associated with a decreased rate of respiratory infection-related admission (hazard ratio: 0.73; 95% confidence interval: 0.58-0.92), while antibiotic prescribing in the previous 7 days (1.92; 1.24-2.96) and prior referral or hospitalization (1.48; 1.20-1.83) were associated with an increased risk of admission. Female sex (0.73; 0.64-0.84), allergic rhinitis (0.48; 0.27-0.83), influenza vaccination (0.75; 0.65-0.87), prior inhaled corticosteroid use (0.63; 0.52-0.76) and antibiotic prescription on the day of diagnosis (0.31; 0.26-0.37) were associated with decreased respiratory infection-related mortality, while a Charlson comorbidity index of > 2 (2.24; 1.72-2.92), antibiotic prescription in the previous 7 days (1.56; 1.20-2.03) and frequent consultation (1.62; 1.09-2.40) were associated with increased mortality. Conclusions Antibiotic prescribing on the day of LRTI diagnosis was associated with reductions in admissions and mortality related to respiratory infection. Antibiotics may help to prevent adverse outcomes for some patients with LRTI.
PMID: 19029433 [PubMed - as supplied by publisher]