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Antibiotics for Common Infections in Primary Care Before, During and after the COVID-19 Pandemic and Extent of Risk-Based Prescribing: Need for Personalised Guidelines

Antibiotics for Common Infections in Primary Care Before, During and after the COVID-19 Pandemic and Extent of Risk-Based Prescribing: Need for Personalised Guidelines

How to cite: Fahmi, Ali and Yang, Ya-Ting and Zhong, Xiaomin and Pate, Alexander and Sharma, Anita and Watts, Simon and Ashcroft, Darren and Goldacre, Ben and Mackenna, Brian and Massey, Jon and Mehrkar, Amir and Bacon, Sebastian and Dark, Paul and Hand, Kieran and Palin, Victoria and Van Staa, Tjeerd P., Antibiotics for Common Infections in Primary Care Before, During and after the COVID-19 Pandemic and Extent of Risk-Based Prescribing: Need for Personalised Guidelines. Available at SSRN: https://ssrn.com/abstract=4626877 or http://dx.doi.org/10.2139/ssrn.4626877

Abstract

Background

To assess whether antibiotics for common infections are prescribed in a risk-based manner and how this changed during the COVID-19 pandemic.

Methods

With the approval of NHS England, we accessed pseudonymised patient-level electronic health records of primary care data from The Phoenix Partnership (TPP) through OpenSAFELY. We included adults registered at general practices in England with a record of common infection, including lower respiratory tract infection (LRTI), upper respiratory tract infections (URTI), and lower urinary tract infection (UTI). Patients with a record of COVID-19 were excluded. Patient-specific risks of infection-related hospital admission were estimated for each infection cohort (not prescribed an antibiotic) using predictors. These predicted non-antibiotic risks were then applied to the antibiotic users and cohorts split into risk deciles.

Findings

We found 15,719,750 diagnoses of common infections from January 2019 to March 2023. Of them, 450,215 (2·86%) were hospitalised in the 30 days after the diagnosis and 10,429,060 (66·34%) prescribed an antibiotic. There were substantial differences in observed rates of hospital admissions between the lowest and highest risk deciles. The probability of prescribed antibiotic was unrelated for LRTI and UTI’s admission risks and weakly for URTI. During the COVID-19 pandemic, the level of risk-based antibiotic prescribing reduced. Predictors were not or only weakly associated with the probability of antibiotic prescribing.

Interpretation

There is a need to better target antibiotics in primary care to patients with worse prognosis and strengthen treatment guidelines in personalisation of prescribing.