{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T20:28:42Z","timestamp":1791232122076,"version":"4.1.0"},"reference-count":42,"publisher":"BMJ","license":[{"start":{"date-parts":[[2016,7,4]],"date-time":"2016-07-04T00:00:00Z","timestamp":1467590400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"abstract":"<jats:p>\n            <jats:bold>Objective<\/jats:bold>\n            \u00a0To determine whether the incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre\u2019s syndrome is higher in general practices that prescribe fewer antibiotics for self limiting respiratory tract infections (RTIs).\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>Design<\/jats:bold>\n            \u00a0Cohort study.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>Setting<\/jats:bold>\n            \u00a0610 UK general practices from the UK Clinical Practice Research Datalink.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>Participants<\/jats:bold>\n            \u00a0Registered patients with 45.5 million person years of follow-up from 2005 to 2014.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>Exposures<\/jats:bold>\n            \u00a0Standardised proportion of RTI consultations with antibiotics prescribed for each general practice, and rate of antibiotic prescriptions for RTIs per 1000 registered patients.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>Main outcome measures<\/jats:bold>\n            \u00a0Incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre\u2019s syndrome, adjusting for age group, sex, region, deprivation fifth, RTI consultation rate, and general practice.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>Results<\/jats:bold>\n            \u00a0From 2005 to 2014 the proportion of RTI consultations with antibiotics prescribed decreased from 53.9% to 50.5% in men and from 54.5% to 51.5% in women. From 2005 to 2014, new episodes of meningitis, mastoiditis, and peritonsillar abscess decreased annually by 5.3%, 4.6%, and 1.0%, respectively, whereas new episodes of pneumonia increased by 0.4%. Age and sex standardised incidences for pneumonia and peritonsillar abscess were higher for practices in the lowest fourth of antibiotic prescribing compared with the highest fourth. The adjusted relative risk increases for a 10% reduction in antibiotic prescribing were 12.8% (95% confidence interval 7.8% to 17.5%, P&lt;0.001) for pneumonia and 9.9% (5.6% to 14.0%, P&lt;0.001) for peritonsillar abscess. If a general practice with an average list size of 7000 patients reduces the proportion of RTI consultations with antibiotics prescribed by 10%, then it might observe 1.1 (95% confidence interval 0.6 to 1.5) more cases of pneumonia each year and 0.9 (0.5 to 1.3) more cases of peritonsillar abscess each decade. Mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre\u2019s syndrome were similar in frequency at low prescribing and high prescribing practices.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>Conclusions<\/jats:bold>\n            \u00a0General practices that adopt a policy to reduce antibiotic prescribing for RTIs might expect a slight increase in the incidence of treatable pneumonia and peritonsillar abscess. No increase is likely in mastoiditis, empyema, bacterial meningitis, intracranial abscess, or Lemierre\u2019s syndrome. Even a substantial reduction in antibiotic prescribing was predicted to be associated with only a small increase in numbers of cases observed overall, but caution might be required in subgroups at higher risk of pneumonia.\n          <\/jats:p>","DOI":"10.1136\/bmj.i3410","type":"journal-article","created":{"date-parts":[[2016,7,4]],"date-time":"2016-07-04T23:32:28Z","timestamp":1467675148000},"page":"i3410","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":118,"title":["Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records"],"prefix":"10.1136","author":[{"given":"Martin C","family":"Gulliford","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael V","family":"Moore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Little","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alastair D","family":"Hay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Fox","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A Toby","family":"Prevost","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorota","family":"Juszczyk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Charlton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Ashworth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2016,7,4]]},"reference":[{"key":"2021050406500617000_354.jul01_5.i3410.1","unstructured":"\u00a0Chief Medical Officer. 2011. Infections and the rise of antimicrobial resistance. Vol 2. Department of Health, 2013. (Annual Report of the Chief Medical Officer.)."},{"key":"2021050406500617000_354.jul01_5.i3410.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00474-2"},{"key":"2021050406500617000_354.jul01_5.i3410.3","unstructured":"\u00a0National Institute for Health and Care Excellence. Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care.National Institute for Health and Clinical Excellence, 2008."},{"key":"2021050406500617000_354.jul01_5.i3410.4","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(13)70294-9"},{"key":"2021050406500617000_354.jul01_5.i3410.5","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD000023.pub4"},{"key":"2021050406500617000_354.jul01_5.i3410.6","first-page":"CD000219","volume":"1","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"2021050406500617000_354.jul01_5.i3410.7","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdp081"},{"key":"2021050406500617000_354.jul01_5.i3410.8","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-006245"},{"key":"2021050406500617000_354.jul01_5.i3410.9","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dku005"},{"key":"2021050406500617000_354.jul01_5.i3410.10","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60994-0"},{"key":"2021050406500617000_354.jul01_5.i3410.11","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.1589"},{"key":"2021050406500617000_354.jul01_5.i3410.12","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD010907.pub2"},{"key":"2021050406500617000_354.jul01_5.i3410.13","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000084"},{"key":"2021050406500617000_354.jul01_5.i3410.14","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39345.405243.BE"},{"key":"2021050406500617000_354.jul01_5.i3410.15","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000172"},{"key":"2021050406500617000_354.jul01_5.i3410.16","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-198903000-00002"},{"key":"2021050406500617000_354.jul01_5.i3410.17","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-015-0975-z"},{"key":"2021050406500617000_354.jul01_5.i3410.18","doi-asserted-by":"publisher","DOI":"10.7326\/M14-1305"},{"key":"2021050406500617000_354.jul01_5.i3410.19","unstructured":"\u00a0Chief Medical Officer. Unusual disease diagnosis. Lemierre\u2019s syndrome. CMO\u2019s Update 29 February 2001.Department of Health, 2001."},{"key":"2021050406500617000_354.jul01_5.i3410.20","unstructured":"Maes N. I thought my awful headache was flu - but it was meningitis. Daily Mail 20th April 2015. Source: http:\/\/www.dailymail.co.uk\/health\/article-3047737\/I-thought-awful-headache-flu-meningitis-s-not-just-children-risk-terrifying-illness-s-easy-adults-mistake-symptoms.html accessed 25th April 2016."},{"key":"2021050406500617000_354.jul01_5.i3410.21","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyv098"},{"key":"2021050406500617000_354.jul01_5.i3410.22","unstructured":"Health and Social Care Information Centre. NHS UK Read codes Clinical Terms Version 3. Leeds: Health and Social Care Information Centre, 2016. 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