Analysing almost 1 million consultations that led to oral antibiotics being prescribed for 13 common conditions from 2013 to 2015, researchers from Public Health England (PHE), the University of Oxford and the Brighton and Sussex Medical School found that respiratory infections and acute cystitis in females were frequently treated with excessively long courses of antibiotics.
Their study, published in the BMJ, showed that 80% or more of antibiotic treatment courses for upper respiratory tract indications, acute cough and bronchitis exceeded guideline recommendations, together with 54.6% (95% CI 54.1–55.0%) of prescriptions for acute cystitis in females.
Prescriptions that exceeded guidelines lasted a median of 2 days beyond the recommended 5 days for acute cough and bronchitis and a median of 4 days beyond the recommended 3 days for acute cystitis in females.
By contast, only 9.6% (95% CI 9.4–9.9%) of prescriptions for acute sinusitis exceeded 7 days and only 2.1% (95% CI 2.0–2.1%) of prescriptions for acute sore throat exceeded 10 days (recent guidance recommends 5 days).
Overtreatment vs undertreatment
Conversely, undertreatment was identified for some conditions. More than half (52.3%) of courses for acute prostatitis were shorter than the recommended 28 days and almost a third (31.8%) of courses for acute cystitis in males were for less than the recommended 7 days.
The authors calculated that prescribing antibiotics for durations recommended by guidelines over the study period would have meant patients receiving 1.1 million fewer days of antibiotics for respiratory indications and 100,000 fewer days of antibiotics for acute cystitis in females.
They speculate that lack of adherence to guidelines could result from several factors, including lack of awareness and scepticism of specific guideline recommendations.
The MIMS table of antibiotic regimens has recently been updated with the latest NICE antimicrobial prescribing guidance for acute cough, COPD exacerbations, sinusitis, prostatitis, UTI and pyelonephritis.