Prescribing for respiratory disease

The last research roundup provided you with an overview of some papers covering the impact of non-medical prescribing in some clearly defined settings (Robertson, 2022). This month we are going to be looking at respiratory disease. The articles reviewed look at delayed prescribing in upper respiratory tract infections, testing and prescribing for lower respiratory tract infections and finally the association between pre-existing respiratory disease and COVID-19.

This original research study, published in the journal of Clinical Infectious Diseases, aimed to provide an overview evaluation of the clinical safety of delaying antibiotic commencement for upper respiratory tract infections (URTIs) and comparing outcomes with those who received an immediate prescription (van Staa, 2021). Delayed prescribing is included in treatment guidelines for less clinically severe URTIs and the researchers used infection-related hospital admission after 30 days as the outcome of interest. Data were obtained from the English Clinical Practice Research database for one cohort, the second cohort in this study had data collected from the Welsh Secure Anonymized Information linkage. These databases contain electronic health records for primary care patients, but they are also linked to hospital admission records for said patients. The diagnosis of URTI was searched for and correlated with patients who had been prescribed one of the following five antibiotics: amoxicillin, clarithromycin, doxycycline, erythromycin, or phenoxymethylpenicillin. Once these patients were identified, the data were then stratified according to whether the prescription had been generated immediately at the point of diagnosis or had been delayed dependent upon the progression of the URTI. For all patient data included, the outcome of interest was as above, infection related hospital admission after a 30 day period. Included data led to 1.4 million data sets being included from the English database and 0.4 million from the Welsh database giving 1.82 million participant data sets included in the analysis. Of this, it was found that 91.7% had an antibiotic at URTI diagnosis date (immediate) and 8.3% had URTI diagnosis in 1-30 days before a prescription was issued (delayed). Further analysis showed that delaying the prescription of antibiotics correlated with a 52% increase in the risk of infection leading to hospital admission. The probability of delayed antibiotic prescribing was unrelated to the predicted risks of hospital admission. Analyses of the number needed to harm showed considerable variability across different patient groups.