Abstract
Inappropriate use of antibiotics is contributing to the increasing rates of antimicrobial resistance. Several Danish guidelines on antibiotic prescribing for acute respiratory tract infections in general practice have been issued to promote rational prescribing of antibiotics, however it is unclear if these recommendations are followed. We aimed to characterise the pattern of antibiotic prescriptions for patients diagnosed with acute respiratory tract infections, by means of electronic prescriptions, labeled with clinical indications, from Danish general practice. Acute respiratory tract infections accounted for 456,532 antibiotic prescriptions issued between July 2012 and June 2013. Pneumonia was the most common indication with 178,354 prescriptions (39%), followed by acute tonsillitis (21%) and acute otitis media (19%). In total, penicillin V accounted for 58% of all prescriptions, followed by macrolides (18%) and amoxicillin (15%). The use of second-line agents increased with age for all indications, and comprised more than 40% of the prescriptions in patients aged >75 years. Women were more often prescribed antibiotics regardless of clinical indication. This is the first Danish study to characterise antibiotic prescription patterns for acute respiratory tract infections by data linkage of clinical indications. The findings confirm that penicillin V is the most commonly prescribed antibiotic agent for treatment of patients with an acute respiratory tract infection in Danish general practice. However, second-line agents like macrolides and amoxicillin with or without clavulanic acid are overused. Strategies to improve the quality of antibiotic prescribing especially for pneumonia, acute otitis media and acute rhinosinusitis are warranted.
Highlights
Antimicrobial resistance rates have reached alarming levels and presently constitute a serious public health concern by threatening one of the most effective and mortality lowering interventions in modern medicine.[1]
A total of 2.4 million systemic antibiotic prescriptions (ATC J01) corresponding to 424 treatments per 1000 inhabitants were issued in the 1-year study period
Acute respiratory tract infections accounted for 456,532 prescriptions, of which pneumonia accounted for 178,354 (39%), followed by tonsillitis (N = 96.549; 21%), acute otitis media (AOM, N = 87.064; 19%), acute rhinosinusitis (N = 81.662; 18%), acute exacerbations of chronic obstructive pulmonary disease (AECOPD) (N = 9967; 2%), and acute bronchitis (N = 2.935; 1%) (Table 1)
Summary
Antimicrobial resistance rates have reached alarming levels and presently constitute a serious public health concern by threatening one of the most effective and mortality lowering interventions in modern medicine.[1]. Acute respiratory tract infections are common reasons for consulting in general practice and assumed responsible for more than 60% of the antibiotic use in this setting.[3] But the effect of antibiotic treatment, when pneumonia is not suspected, is at best moderate,[4,5,6] indicating that a large amount of antibiotic prescriptions are inappropriate and confer no net benefit for the patient. Strategies, such as guidelines on rational antibiotic use, as well as educational and decision support systems are applied to improve antibiotic prescribing. The implementation of these strategies into daily clinical routine can be difficult and daily practice is far from optimal[7, 8] in turn augmenting the risk of inappropriate prescribing both in regard to quantity (e.g., overprescribing) and quality (e.g., non-optimal choice of antibiotic).[9]
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