Research into repeat prescriptions for antibiotics for respiratory tract infections by GPs has shown that they are widely prescribed in the UK, despite evidence that they provide little benefit to the patient. Researchers (from the universities of Bristol and Bath, King's College London and UMC Utrecht) are therefore calling for repeat prescriptions to be reduced and that they are specifically targeted in interventions to promote rational antibiotic use.

Respiratory tract infections (RTIs) are one of the most common reasons why people visit a general practitioner (GP) in the United Kingdom (UK). Many RTIs are caused by viruses, and general practice guidelines recommend that antibiotics should not be prescribed or should only be prescribed as a secondary treatment in the vast majority of patients. Despite this, 54 percent of GP visits due to a RTI in the UK result in antibiotics being prescribed. Worldwide, RTIs account for 60 percent of the number of prescriptions for antibiotics by general practitioners, and partly because of this, RTIs are one of the main drivers of antibiotic resistance. Much is already known about the prescription behavior by general practitioners of antibiotics for RTIs. However, because little has been described about repeat prescriptions in the scientific literature, English and Dutch researchers investigated this specific aspect.

Frequent repeat prescriptions

The study, which analyzed more than 900,000 RTIs in a registry of patient records from 530 English general practices, found that nearly 20 percent of adults and 10 percent of children were prescribed a second course of antibiotics within the same episode of a lower RTI. Nearly half (48.3 percent) of these repeat prescriptions involved an antibiotic from the same class. Previous research has shown that for most children and adults with lower RTIs, especially those without chronic lung disease, antibiotic therapy is unlikely to work. However, this does raise concerns about excessive antibiotic use leading to development of antibiotic resistance.

The study further found that GPs were more likely to prescribe a repeat prescription for antibiotics when a patient visits the GP frequently because of a RTI and when a patient has received a repeat prescription for antibiotics previously. Age was also an important factor, with both young children (younger than 2 years of age) and older adults (older than 65 years of age) receiving repeat prescriptions more often.

Utrecht expertise

UMC Utrecht works closely with the University of Bristol in advocating and studying the promotion of rational antibiotic use (often called "antimicrobial stewardship") and has considerable epidemiological expertise in analyzing sophisticated UK electronic patient records.

Arief Lalmohamed, hospital pharmacist and associate professor at UMC Utrecht and first author of the study, said, "Repeated antibiotic use within an episode of RTI accounts for a significant proportion of all antibiotics prescribed. In light of our findings, it is clear that interventions on promoting rational antibiotic use must go beyond just the first antibiotic prescription to address unnecessary repeat prescriptions."

Alastair Hay, general practitioner and professor of primary care at the Centre for Academic Primary Care at the University of Bristol, and principal investigator of the study, added: "It seems implausible that repeating antibiotic courses has any benefit, given that there is clear evidence that children and adults without chronic lung disease do not benefit from an initial antibiotic course, and that authorities in the UK only recommend a 5-day course of antibiotics for severe lower RTIs such as pneumonia."

Publication

Lalmohamed A, Venekamp RP, Bolhuis A, Souverein PC, Wijgert JHHM van de, Gulliford MC, Hay AD. Within-episode repeat antibiotic prescriptions in patients with respiratory infections: a population-based cohort study. Journal of Infection 2024;88:106135