Antibiotic prescription in emergency dental service in Zagreb, Croatia – a retrospective cohort study

Background: Antibiotic overuse is linked with increased risk of antimicrobial resistance. Long-term antibiotics are commonly used for treating acne and prophylaxis of urinary tract infection. Their contribution to the overall burden of antibiotic use is relatively unknown. Aim: To describe the volume of commonly prescribed long-term (>= 28 days) antibiotic prescriptions in adolescents and young adults, trends over time and comparisons with acute prescriptions. Design and Setting: Retrospective cohort study using UK electronic primary care records. Methods: Patients born between 1979 and 1996 in the Care and Health Information Analytics database were included. Our main outcome measures were antibiotic prescription rates per 1000 person years, antibiotic prescription days per person year between ages 11-21. Results: 320,722 participants received a total of 710,803 antibiotic prescriptions between the ages of 11-21 from 1998 to 2017. 191,443/710,803 (26.93%) prescriptions were for long-term antibiotics (≥28 days and ≤ 6 months in duration). Long-term antibiotics accounted for more than two-thirds (72.48%) of total antibiotic exposure (days per person year). Total long-term antibiotic prescribing peaked in 2013 at just under 6 days per person year and declined to around 4 in 2017. Conclusions: Amongst adolescents and young adults, exposure to long-term antibiotics (primarily lymecycline used for acne) was much greater than for acute antibiotics and is likely to make an important contribution to antimicrobial resistance. Urgent action is needed to reduce unnecessary exposure to long-term antibiotics in this group. Increasing the use of and adherence to effective, non-antibiotic treatments for acne is key to achieving this.

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Antibiotic use and serious complications following acute otitis media and acute sinusitis: a retrospective cohort study

British Journal of General Practice ◽

10.3399/bjgp20x708821 ◽

2020 ◽

Vol 70 (693) ◽

pp. e255-e263 ◽

Cited By ~ 2

Author(s):

Rebecca Cushen ◽

Nick A Francis

Keyword(s):

Cohort Study ◽

Brain Abscess ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Antibiotic Prescription ◽

Acute Otitis Media ◽

Orbital Cellulitis ◽

Antibiotic Prescribing ◽

Acute Mastoiditis ◽

Lower Odds

BackgroundMost people with acute otitis media (AOM) and acute sinusitis (AS) do not benefit from antibiotics, and GPs are under increasing pressure to reduce antibiotic prescribing. Concern about the risk of complications can drive unnecessary prescribing.AimTo describe the incidence of serious complications following AOM and AS, and to determine whether antibiotics are protective.Design and settingThis was a retrospective cohort study using the Clinical Practice Research Datalink database to identify patients diagnosed in general practice with AOM or AS between 1 January 1982 and 31 December 2012.MethodThe incidence of brain abscess and acute mastoiditis following AOM, and of brain abscess and orbital cellulitis following AS, were calculated, as was the association between antibiotics and the development of these complications and numbers needed to treat (NNT).ResultsThe incidence of brain abscess and acute mastoiditis following AOM were 0.03 (95% confidence interval [CI] = 0.01 to 0.20) and 5.62 (95% CI = 4.81 to 6.56) per 10 000 AOM episodes, respectively. The incidence of brain abscess and orbital cellulitis following AS was 0.11 (95% CI = 0.05 to 0.26) and 1.50 (95% CI = 1.17 to 1.90) per 10 000 AS episodes, respectively. Antibiotic prescription for AOM was associated with lower odds of developing acute mastoiditis (odds ratio [OR] 0.54; 95% CI = 0.37 to 0.79); NNT to prevent one case was 2181 (95% CI = 1196 to 5709). Antibiotic prescribing for AS was associated with lower odds of subsequent brain abscess (OR 0.12; 95% CI = 0.02 to 0.70); NNT to prevent one case was 19 988 (95% CI = 4951 to 167 099). No significant association between antibiotic prescription and development of orbital cellulitis following AS were found (OR 0.56; 95% CI = 0.27 to 1.12).ConclusionSerious complications following AOM and AS are rare. Antibiotics are associated with lower odds of developing complications, but the NNT are large.

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To prescribe or not to prescribe for paediatric sore throat: a retrospective cohort study comparing clinician-led antibiotic prescriptions to FeverPAIN and Centor scoring in a tertiary paediatric emergency department and a national review of practice

Emergency Medicine Journal ◽

10.1136/emermed-2020-210786 ◽

2021 ◽

pp. emermed-2020-210786

Author(s):

Michael Malley ◽

Katie Driver ◽

Megan Costelloe ◽

Isla Monaghan ◽

Lucy Jefferson ◽

...

Keyword(s):

Cohort Study ◽

Sore Throat ◽

Retrospective Cohort Study ◽

Emergency Departments ◽

Retrospective Cohort ◽

Antibiotic Prescription ◽

Scoring Systems ◽

Prescription Rates ◽

National Practice ◽

Clinician Practice

BackgroundTonsillopharyngitis is a common presentation to paediatric emergency departments (PEDs). FeverPAIN (FP) and Centor scoring systems are recommended in the UK to help delineate bacterial aetiology, despite being primarily evidenced in adult populations. We investigate how the use of FP or Centor compares to actual clinician practice in guiding antibiotic prescription rates in PED. We establish current national practice in English PEDs.MethodsWe performed a retrospective cohort study of tonsillopharyngitis presentations to a tertiary PED in January–February 2020. Investigators retrospectively assigned each patient FP and Centor scores using documented symptoms. We compared antibiotic prescription rates guided by FP/Centor against the actual rate prescribed by clinicians, and assessed agreement between these strategies using kappa analysis. We contacted 153 English emergency departments to establish national practice.ResultsWe identified 632 consecutive patients aged 6 months to 15 years. Actual clinician-prescribed antibiotics numbered 116 (18.4%). Prescriptions predicted by FP score numbered 124 (19.6%) and Centor 112 (17.7%). Kappa (K) analysis indicated only moderate agreement between clinician choice versus FP (K=0.434) and clinician choice versus Centor (K=0.476). This was similar for cohorts aged under and over 3 years.National practice was reportedly heterogeneous, with 70 emergency departments (45.8%) not employing a specific system.ConclusionCurrent guidance is variably interpreted and inconsistently implemented in paediatric populations. FeverPAIN and Centor scoring systems may not rationalise antibiotics as much as previously reported compared with judicious clinician practice. Producing clear paediatric-specific national guidelines, especially for under-5s who are omitted from NICE sore throat guidance, may help further rationalise and standardise antibiotic use in paediatric tonsillopharyngitis.

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