Antibiotic prescribing and resistance in primary care: implications for intervention

Van Hecke, O

Abstract:: Background

Antibiotic resistance is an important societal health issue. The greatest risk factor for developing a resistant infection is antibiotic use. Almost 75% of all antibiotics in the UK are prescribed in the community, and mostly for acute respiratory tract infections (RTIs). Yet, the majority of RTIs are self-limiting, viral and do not need antibiotic treatment, especially in young children. While the effects of antibiotic-resistant infections have been widely studied...
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APA Style

Van Hecke, O. (2017). Antibiotic prescribing and resistance in primary care: implications for intervention [PhD thesis]. University of Oxford.

MLA Style

Van Hecke, O. Antibiotic Prescribing and Resistance in Primary Care: Implications for Intervention. 2017. University of Oxford, PhD thesis.

Chicago Style

Van Hecke, O. 2017. “Antibiotic Prescribing and Resistance in Primary Care: Implications for Intervention.” PhD thesis, University of Oxford.
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Files:: MERGED Oliver van Hecke Thesis.pdf

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Authors

+ Van Hecke, O More by this author

Division:: MSD
Department:: Primary Care Health Sciences
Department:: University of Oxford
Role:: Author

Contributors

+ Butler, C

Department:: University of Oxford
Role:: Supervisor

+ Wang, K

Department:: University of Oxford
Role:: Supervisor

+ Tonkin-Crine, S

Department:: University of Oxford
Role:: Supervisor

+ National Institute of Health Research School of Primary Care Research More from this funder

Grant:: Grant reference: 366

+ Scientific Foundation Board, Royal College of General Practitioners More from this funder

Grant:: SFB 2015-33

DOI:: 10.5287/ora-pr8enkpgy
Type of award:: DPhil
Level of award:: Doctoral
Awarding institution:: University of Oxford

Language:: English
Keywords:: Primary Care

Public Health

Antibiotic resistance

Ambulatory Care

Infection
Subjects:: Drug resistance in microorganisms

Public health

Infections

Primary care
UUID:: uuid:ae1729c2-55ed-479b-af43-0d29c0a642ff
Deposit date:: 2018-06-15
ARK identifier:: ark:/29072/ora_ae1729c255ed479baf430d29c0a642ff

Related item:: Implications of Antibiotic Resistance for Patients’ Recovery From Common Infections in the Community: A Systematic Review and Meta-analysis
Description:: Background. Antibiotic use is the main driver for carriage of antibiotic-resistant bacteria. The perception exists that failure of antibiotic treatment due to antibiotic resistance has little clinical impact in the community. Methods. We searched MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials, and Web of Science from inception to 15 April 2016 without language restriction. We included studies conducted in community settings that reported patient-level data on laboratory-confirmed infections (respiratory tract, urinary tract, skin or soft tissue), antibiotic resistance, and clinical outcomes. Our primary outcome was clinical response failure. Secondary outcomes were reconsultation, further antibiotic prescriptions, symptom duration, and symptom severity. Where possible, we calculated odds ratios with 95% confidence intervals by performing meta-analysis using random effects models. Results. We included 26 studies (5659 participants). Clinical response failure was significantly more likely in participants with antibiotic-resistant Escherichia coli urinary tract infections (odds ratio [OR] = 4.19; 95% confidence interval [CI] = 3.27–5.37; n = 2432 participants), Streptococcus pneumoniae otitis media (OR = 2.51; 95% CI = 1.29–4.88; n = 921 participants), and S. pneumoniae community-acquired pneumonia (OR = 2.15; 95% CI = 1.32–3.51; n = 916 participants). Clinical heterogeneity precluded primary outcome meta-analysis for Staphylococcus aureus skin or soft-tissue infections. Conclusions. Antibiotic resistance significantly impacts on patients’ illness burden in the community. Patients with laboratory- confirmed antibiotic-resistant urinary and respiratory-tract infections are more likely to experience delays in clinical recovery after treatment with antibiotics. A better grasp of the risk of antibiotic resistance on outcomes that matter to patients should inform more meaningful discussions between healthcare professionals and patients about antibiotic treatment for common infections.

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Copyright holder:: Van Hecke, O

Licence:: Terms and Conditions of Use for Oxford University Research Archive

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Antibiotic prescribing and resistance in primary care: implications for intervention

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