Antibiotic prescribing and outcomes of lower respiratory tract infection in UK primary care

Christopher C. Winchester* (Corresponding Author), Tatiana MacFarlane, Mike Thomas, David Price

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

42 Citations (Scopus)


Background: Lower respiratory tract infection (LRTI) is common in the community and may result in hospitalization or death. This observational study aimed to investigate the role of antibiotics in the management of LRTI in the primary care setting in the United Kingdom.

Methods: Patients receiving a first diagnosis of LRTI during 2004 and satisfying inclusion and data quality criteria were identified in the General Practice Research Database. Factors associated with respiratory infection-related hospital admissions and death in the 3 months following the initial diagnosis were identified using Cox proportional hazards regression.

Results: Antibiotic prescribing on the day of diagnosis was associated with a decreased rate of respiratory, infection-related hospital admission (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.58 to 0.92), while antibiotic prescribing in the previous 7 days (HR, 1.92; 95% CI, 1.24 to 2.96) and prior referral or hospitalization (HR, 1.48; 95% CI, 1.20 to 1.83) were associated with an increased risk of hospital admission. Female sex (HR, 0.73; 95% CI, 0.64 to 0.84), allergic rhinitis (HR, 0.48; 95% CI, 0.27 to 0.83), influenza vaccination (HR, 0.75; 95% CI, 0.65 to 0.87), prior inhaled corticosteroid use (HR, 0.63; 95% CI, 0.52 to 0.76), and antibiotic prescription on the day of diagnosis (HR, 0.31; 95% CI, 0.26 to 0.37) were associated with decreased respiratory infection-related mortality, while a Charlson comorbidity index of >= 2 (HR, 2.24; 95% CI, 1.72 to 2.92), antibiotic prescription in the previous 7 days (HR, 1.56; 95% CI, 1.20 to 2.03), and frequent consultation (HR, 1.62; 95% CI, 1.09 to 2.40) were associated with increased mortality.

Conclusions: Antibiotic prescribing on the day of LRTI diagnosis was associated with reductions in hospital admissions and mortality related to respirator), infection. Antibiotics may, help to prevent adverse outcomes for some patients with LRTI. (CHEST 2009; 135:1163-1172)

Original languageEnglish
Pages (from-to)1163-1172
Number of pages10
Issue number5
Publication statusPublished - May 2009

Bibliographical note

The authors thank the International Primary Care Respiratory Group for its generous provision of funding; the Medical Research Council for providing access to the GPRD; Ana Ruigómez at the Spanish Centre for Pharmacoepidemiological Research (CEIFE) and Tarita Murray-Thomas and colleagues at the GPRD for advice and comments on the study design and analysis; Julie von Ziegenweidt, Samantha Louw, and Siân Williams for their support; and the PCPs participating in the GPRD for contributing the data on which this study is based. We would also like to acknowledge the contributions of David Honeybourne, Paul Little, Dick Mayon-White, Robert Read, Martin Wale, and Adèle Weston, who participated in a round-table meeting on antibiotic prescribing trends and patient outcomes sponsored by Abbott Laboratories, at which the idea of a study using the GPRD to assess the effects of antibiotic prescribing on outcomes of LRTI was first discussed.


  • practice research database
  • general-practice
  • United-Kingdom
  • hospital admissions
  • trends
  • complications
  • disease
  • risk
  • time
  • consultations


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