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Original Research: ANTIBIOTICS AND RESPIRATORY INFECTIONS |

Antibiotic Prescribing and Outcomes of Lower Respiratory Tract Infection in UK Primary Care

Christopher C. Winchester, DPhil; Tatiana V. Macfarlane, PhD; Mike Thomas, MBBS; David Price, MB BChir
Author and Funding Information

*From the Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen, UK.

Correspondence to: Christopher C. Winchester, DPhil, Clinical Research Fellow, Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Rd, Aberdeen AB25 2AY, UK; e-mail: c.winchester@abdn.ac.uk


This study is based in part on data from the Full Feature General Practice Research Database obtained under license from the UK Medicines and Healthcare Products Regulatory Agency. However, the interpretation and conclusions contained in this study are those of the authors alone. The original idea for the study and the protocol were formulated by Drs. Winchester, Thomas, and Price, with subsequent advice and statistical input from Dr. Macfarlane, who also performed the statistical analyses. Dr. Winchester drafted the manuscript, with extensive contributions and revision from all authors.

Access to the General Practice Research Database was funded through the Medical Research Council's license agreement with the Medicines and Healthcare Products Regulatory Agency. This study was funded by the International Primary Care Respiratory Group, which reviewed and approved the design of the study.

Dr. Winchester is employed as a medical writer by Oxford PharmaGenesis Ltd. He and Oxford PharmaGenesis have received no industry funding for this research and are undertaking no industry-sponsored projects related to antibiotics or respiratory infection. Dr. Thomas received an honorarium for giving a lecture at an educational meeting arranged by Abbott Laboratories in 2007. Dr. Price is on the independent steering committee of a study looking at the treatment of lower respiratory tract infection in Europe sponsored by Bayer Healthcare; also, he chairs the Research Subcommittee of the International Primary Care Respiratory Group but was not involved in approving this study for funding. Dr. Macfarlane has reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).

For editorial comment see page 1118


© 2009 American College of Chest Physicians


Chest. 2009;135(5):1163-1172. doi:10.1378/chest.07-2940
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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 the primary care setting in the United Kingdom.

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 hospital admissions and death in the 3 months following the 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 hospital admission (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.58 to 0.92), while antibiotic prescribing in the previous 7 days (HR, 1.92; 95% CI, 1.24 to 2.96) and prior referral or hospitalization (HR, 1.48; 95% CI, 1.20 to 1.83) were associated with an increased risk of hospital admission. Female sex (HR, 0.73; 95% CI, 0.64 to 0.84), allergic rhinitis (HR, 0.48; 95% CI, 0.27 to 0.83), influenza vaccination (HR, 0.75; 95% CI, 0.65 to 0.87), prior inhaled corticosteroid use (HR, 0.63; 95% CI, 0.52 to 0.76), and antibiotic prescription on the day of diagnosis (HR, 0.31; 95% CI, 0.26 to 0.37) were associated with decreased respiratory infection-related mortality, while a Charlson comorbidity index of ≥ 2 (HR, 2.24; 95% CI, 1.72 to 2.92), antibiotic prescription in the previous 7 days (HR, 1.56; 95% CI, 1.20 to 2.03), and frequent consultation (HR, 1.62; 95% CI, 1.09 to 2.40) were associated with increased mortality.

Conclusions:  Antibiotic prescribing on the day of LRTI diagnosis was associated with reductions in hospital admissions and mortality related to respiratory infection. Antibiotics may help to prevent adverse outcomes for some patients with LRTI.

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