Antibiotic Prescribing in General
Why a Hot Topic?
• Drug and Therapeutics Bulletin-April 07
-Avoiding Antibiotic Overuse in Primary
• BMJ August 2007
-Effect of Antibiotic prescribing on
Antibiotic resistance in individual
children in primary care:prospective
So when should we
than a giraffe
with a sore
• Approx 85% will self resolve within 1
• Usually viral
• Serious complications rare
• Symptomatic relief
• Phenoxymethylpenicillin –10days tx
• Delayed prescriptions for use after 3
Antibiotic use in Sore Throat
• Cochrane review- 26 studies-12,669 patients
• Significant reduction in incidence of
• Compared with placebo 71 patients would need to
be treated with antibiotics to prevent one patient
from suffering AOM and 50 patients to prevent
one case of quinsy.
• Significant reduction in symptoms of sore throat
and fever at day 3 with antibiotic use.
• Tonsillar exudate
• Tender anterior cervical lymph nodes
• Absence of cough
• History of fever
Common AOM & OME
¾ occur in children under 10 years old
AOM- viral or bacterial
80% recover within 3 days without Antibiotic
Antibiotic use in AOM
• Cochrane Review 8
RCT’s -2287 cases
• 2/3 no pain after 24
Antibiotic or Placebo
• Use of delayed
• 5 days treatment
Interventions to help Inappropriate
• Patient and prescriber education
• -questionnaire study in Australia
“Strongest determinants of prescribing
were the doctors’ opinions about the
patients expectations regarding
• Communication tools for avoiding
inappropriate antibiotic prescribing
1. Del Mar C. Prescribing antibiotics in Primary Care. BMJ 2007;
2. Harnden A, Perera R, Brueggemann A et al. Respiratory
infections for which general practitionerls consider prescribing
an antibiotic:a prospective study. Arh Dis Child 2007;92:594-
3. Malmvall B, Molstad S, Darelid J et al. Reduction of antibiotic
sales and sustained low incidence of bacterial
resistance:Report on a broad approach during 10years to
implement evidence-based indications for antibiotic
prescribing in Jonkoping County,Sweden. Quality
Management in Health Care 2007;16(1):60-7.
4. Mangione-Smith R, Stivers T, Elliott M et al. Online
commentary during physical examination:a communication
tool for avoiding inappropriate antibiotic prescribing. Social
Science & Medicine 2003;56(2):313-320.
5. Antibiotic prescribing practices in ambulatory care.
Cochrane Database of Systematic Reviews 2007 Issue 3.
6. Little P. Delayed Prescribing of antibiotics for upper
respiratory tract infection BMJ 2005;331:301-302
7. Sore Throat.MeReC Bulletin. Dec 06;Volume 17:no 3
8. Acute Otitis Media.MeReC Bulletin.Dec 06:Volume 17:no 3.
9. Kenealy T. Sore Throat. Clinical evidence May 2006.
10. NICE draft scope for guideline on respiratory tract infection
-antibiotic prescribing July 2007
11. Chung A, Perera R, Brueggemann A. Effect of antibiotic
prescribing on antibiotic resistance in individual children in
primary care:prospective cohort study. BMJ 2007;335;429.