The effectiveness of frequent antibiotic use in reducing the risk of infection-related hospital admissions: results from two large population-based cohortsCitation formats

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@article{e13f7a4ca0984ebfa043619789b9a3ff,
title = "The effectiveness of frequent antibiotic use in reducing the risk of infection-related hospital admissions: results from two large population-based cohorts",
abstract = "BackgroundPrevious research reported that individuals prescribed antibiotics frequently develop antimicrobial resistance. The objective of this study was to evaluate whether frequent antibiotic use is associated with reduced hospital admissions for infection-related complications.MethodsPopulation-based cohort study analysing electronic health records from primary care linked to hospital admission records. The study population included patients prescribed a systemic antibiotic, recent record of selected infections and no history of chronic obstructive pulmonary disease. Propensity-matched cohorts were identified based on quintiles of prior antibiotic use in 3 years before.ResultsA total of 1.8 million patients were included. Repeated antibiotic use was frequent. The highest rates of hospital admissions for infection-related complications were observed shortly after antibiotic start in all prior exposure quintiles. For patients with limited prior antibiotic use, rates then dropped quickly and substantially. In contrast, reductions over time were substantially less in patients with frequent prior antibiotic use, with rates remaining elevated over the following 6 months. In patients without comorbidity comparing the highest to lowest prior exposure quintiles in the Clinical Practice Research Databank, the IRRs were 1.18 [95% CI 0.90–1.55] in the first 3 days after prescription, 1.44 [95% CI 1.14–1.81] in the days 4–30 after and 3.22 [95% CI 2.29–4.53] in the 3–6 months after.ConclusionsRepeated courses of antibiotics, although common practice, may have limited benefit and indicator of adverse outcomes. A potential mechanism is that antibiotics may cause dysbiosis (perturbations of intestinal microbiota), contributing to colonization with resistant bacteria. Antibiotics should be used judiciously and only periodically unless indicated. Antimicrobial stewardship should include activities focusing on the substantive number of patients who repeatedly but intermittently get antibiotics.",
keywords = "Antibiotics, Effectiveness, Epidemiology, Infection-related complications, Primary care",
author = "{Van Staa}, {Tjeerd Pieter} and Victoria Palin and Yan Li and William Welfare and Felton, {Timothy W.} and Paul Dark and Ashcroft, {Darren M.}",
note = "Funding Information: This study was co-funded by Connected Health Cities and the NIHR Manchester Biomedical Research Centre. Connected Health Cities is a Northern Health Science Alliance led programme funded by the Department of Health and delivered by a consortium of academic and NHS organizations across the north of England. Publisher Copyright: {\textcopyright} 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",
year = "2020",
month = mar,
day = "2",
doi = "10.1186/s12916-020-1504-5",
language = "English",
volume = "18",
pages = "40",
journal = "BMC Medicine",
issn = "1741-7015",
publisher = "Springer Nature",
number = "1",

}

RIS

TY - JOUR

T1 - The effectiveness of frequent antibiotic use in reducing the risk of infection-related hospital admissions: results from two large population-based cohorts

AU - Van Staa, Tjeerd Pieter

AU - Palin, Victoria

AU - Li, Yan

AU - Welfare, William

AU - Felton, Timothy W.

AU - Dark, Paul

AU - Ashcroft, Darren M.

N1 - Funding Information: This study was co-funded by Connected Health Cities and the NIHR Manchester Biomedical Research Centre. Connected Health Cities is a Northern Health Science Alliance led programme funded by the Department of Health and delivered by a consortium of academic and NHS organizations across the north of England. Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

PY - 2020/3/2

Y1 - 2020/3/2

N2 - BackgroundPrevious research reported that individuals prescribed antibiotics frequently develop antimicrobial resistance. The objective of this study was to evaluate whether frequent antibiotic use is associated with reduced hospital admissions for infection-related complications.MethodsPopulation-based cohort study analysing electronic health records from primary care linked to hospital admission records. The study population included patients prescribed a systemic antibiotic, recent record of selected infections and no history of chronic obstructive pulmonary disease. Propensity-matched cohorts were identified based on quintiles of prior antibiotic use in 3 years before.ResultsA total of 1.8 million patients were included. Repeated antibiotic use was frequent. The highest rates of hospital admissions for infection-related complications were observed shortly after antibiotic start in all prior exposure quintiles. For patients with limited prior antibiotic use, rates then dropped quickly and substantially. In contrast, reductions over time were substantially less in patients with frequent prior antibiotic use, with rates remaining elevated over the following 6 months. In patients without comorbidity comparing the highest to lowest prior exposure quintiles in the Clinical Practice Research Databank, the IRRs were 1.18 [95% CI 0.90–1.55] in the first 3 days after prescription, 1.44 [95% CI 1.14–1.81] in the days 4–30 after and 3.22 [95% CI 2.29–4.53] in the 3–6 months after.ConclusionsRepeated courses of antibiotics, although common practice, may have limited benefit and indicator of adverse outcomes. A potential mechanism is that antibiotics may cause dysbiosis (perturbations of intestinal microbiota), contributing to colonization with resistant bacteria. Antibiotics should be used judiciously and only periodically unless indicated. Antimicrobial stewardship should include activities focusing on the substantive number of patients who repeatedly but intermittently get antibiotics.

AB - BackgroundPrevious research reported that individuals prescribed antibiotics frequently develop antimicrobial resistance. The objective of this study was to evaluate whether frequent antibiotic use is associated with reduced hospital admissions for infection-related complications.MethodsPopulation-based cohort study analysing electronic health records from primary care linked to hospital admission records. The study population included patients prescribed a systemic antibiotic, recent record of selected infections and no history of chronic obstructive pulmonary disease. Propensity-matched cohorts were identified based on quintiles of prior antibiotic use in 3 years before.ResultsA total of 1.8 million patients were included. Repeated antibiotic use was frequent. The highest rates of hospital admissions for infection-related complications were observed shortly after antibiotic start in all prior exposure quintiles. For patients with limited prior antibiotic use, rates then dropped quickly and substantially. In contrast, reductions over time were substantially less in patients with frequent prior antibiotic use, with rates remaining elevated over the following 6 months. In patients without comorbidity comparing the highest to lowest prior exposure quintiles in the Clinical Practice Research Databank, the IRRs were 1.18 [95% CI 0.90–1.55] in the first 3 days after prescription, 1.44 [95% CI 1.14–1.81] in the days 4–30 after and 3.22 [95% CI 2.29–4.53] in the 3–6 months after.ConclusionsRepeated courses of antibiotics, although common practice, may have limited benefit and indicator of adverse outcomes. A potential mechanism is that antibiotics may cause dysbiosis (perturbations of intestinal microbiota), contributing to colonization with resistant bacteria. Antibiotics should be used judiciously and only periodically unless indicated. Antimicrobial stewardship should include activities focusing on the substantive number of patients who repeatedly but intermittently get antibiotics.

KW - Antibiotics

KW - Effectiveness

KW - Epidemiology

KW - Infection-related complications

KW - Primary care

UR - http://www.scopus.com/inward/record.url?scp=85080840525&partnerID=8YFLogxK

U2 - 10.1186/s12916-020-1504-5

DO - 10.1186/s12916-020-1504-5

M3 - Article

C2 - 32114981

VL - 18

SP - 40

JO - BMC Medicine

JF - BMC Medicine

SN - 1741-7015

IS - 1

M1 - 40

ER -