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Examining the inter-relationships between antibiotic prescribing, complications and resistance in acute respiratory tract infections

Cannings-John, Rebecca 2013. Examining the inter-relationships between antibiotic prescribing, complications and resistance in acute respiratory tract infections. PhD Thesis, Cardiff University.
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Abstract

The threat to public health from antibiotic resistance has increased, with growing evidence that antibiotic use is a major driver of resistance. This has led to campaigns to reduce prescribing of antibiotics by GPs, particular for respiratory tract infections (RTIs). These are among the most common reasons for prescribing antibiotics in primary care, in spite of the fact that there is evidence that most RTIs recover at a similar rate without antibiotic treatment, rarely resulting in complications if untreated. There are concerns, that a ‘blanket’ reduction in prescribing may occur, with reductions in prescribing that may benefit patients, leading to an increase in complications that can arise from untreated RTIs. The aim of this thesis was to explore the relationships between community antibiotic dispensing, complications from RTIs and resistance. We showed that decreasing rates of antibiotic dispensing in Wales coincided with increases in hospital diagnosed complications such as pneumonia and septicaemia from 1996-2006. At a practice level, there was evidence of a negative association between dispensing and complications. While a positive association was found between lagged dispensing and resistance, no clear pattern was found between change in dispensing and resistance for any of the organism/ antibiotic combinations examined possibly due to a lack of power. At an individual patient level, antibiotics are not justified to reduce the risk of a complication in those diagnosed with an acute RTI or sore throat. However, for patients presenting with a chest infection, the risk of developing a complication is higher and antibiotics appear to reduce the risk of complications; GPs should therefore consider prescribing for these patients. Further research is required to examine different lag periods of dispensing and their association with resistance and also to identify subgroups of patients at high risk of complications to help GPs target their prescribing of antibiotics.

Item Type: Thesis (PhD)
Status: Unpublished
Schools: Medicine
Subjects: R Medicine > RC Internal medicine
Funders: Welsh Government, Cardiff University School of Medicine
Date of First Compliant Deposit: 30 March 2016
Last Modified: 04 Jun 2017 04:59
URI: http://orca.cf.ac.uk/id/eprint/47245

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