It is known that infections are becoming more resistant to treatment by antibiotics (ABs). This could be because ABs are being prescribed too frequently. We need to make sure that ABs are only prescribed when they are really needed. We don't know what level of AB use in primary care is acceptable and safe. This research investigates the safety of reducing AB prescription in primary care, and to understand the impact of policies aimed at reducing AB prescribing. We will compile a full list of possible infection complications and relevant patient outcomes if such a policy was adopted. We will then study primary care patient electronic health records to find out if the risk of each outcome is greater (or not) when ABs are not prescribed. We will also analyse Hospital Episode and mortality statistics. The data will be analysed in several different ways. We will look at it from an individual patient perspective and also across general practices. We want to identify those groups where risk of each infection complication is greatest. This will include sub-groups of age, gender, associated health conditions, and in very old people, according to their level of frailty using an established frailty measure.
Antimicrobial drug resistance (AMR) is a growing threat. Many antibiotic (AB) prescriptions in primary care are unnecessary and the NHS is now incentivising reduced AB prescribing in primary care. This research asks whether it is safe to reduce AB prescribing in primary care? Is there a risk that bacterial infections might be more frequent if ABs are prescribed less often? We will systematically identify a comprehensive list of safety outcomes relevant to a policy to reduce overall AB utilisation in primary care. Case definitions will be developed. A cohort study will be conducted using electronic health records (EHRs) from the Clinical Practice Research Datalink (CPRD) with linked hospital episode, mortality and deprivation data. At population- (general practice-) level, we will estimate the incidence of each safety outcome by level of AB prescribing. At individual-level, we will conduct a series of epidemiological studies to evaluate relative and absolute risks of safety outcomes, allowing for confounding by indication using appropriate epidemiological methods. We will obtain estimates for the primary care population stratified by age-group, gender, comorbidity status, smoking, deprivation and, in older adults, frailty level using e-Frailty index.
We will analyse as outcomes bacterial infections that might potentially be complications arising from a policy of reducing antibiotic prescriptions in primary care. We will develop a comprehensive listing as part of this research. We will specifically include pneumonia, peritonsillar abscess, mastoiditis, bacterial meningitis, intracranial abscess, empyema and Lemierre's syndrome. We also expect to include septicaemia, toxic shock syndrome, pyelonephritis, osteomyelitis, septic arthritis and Scarlet fever. We will also include as outcomes cause-specific mortality and hospital admissions from these conditions, using linked data for ascertainment.
Martin Gulliford - Chief Investigator - King's College London (KCL)
Martin Gulliford - Corresponding Applicant - King's College London (KCL)
Catey Bunce - Collaborator - King's College London (KCL)
Judith Charlton - Collaborator - King's College London (KCL)
Mark Ashworth - Collaborator - King's College London (KCL)
Xiaohui Sun - Collaborator - King's College London (KCL)
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation