ArticleThe Journal of antimicrobial chemotherapy2018
Actual versus 'ideal' antibiotic prescribing for common conditions in English primary care.
Article in The Journal of antimicrobial chemotherapy, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05286918 (Antibiotic Stewardship Through CRP-guided Antibiotic Treatment for Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease), which is not on this map. Cited by 123 papers, 8 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Antibiotic Stewardship Through CRP-guided Antibiotic Treatment for Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD)
Who cites it
123 citing papers in PubMed, 8 syntheses or guidelines pooled it, 192 citations in OpenAlex.
- Pooled it
- Nudge interventions to reduce unnecessary antibiotic prescribing in primary care: a systematic review.BMJ open · 2023Pooled it
- Biomarkers to guide the use of antibiotics for acute exacerbations of COPD (AECOPD): a systematic review and meta-analysis.BMC pulmonary medicine · 2022Pooled it
- Pediatric Outpatient Prescriptions in Countries With Advanced Economies in the 21st Century: A Systematic Review.JAMA network open · 2022Pooled it
- Pooled it
- Delayed antibiotic prescribing for respiratory tract infections: individual patient data meta-analysis.BMJ (Clinical research ed.) · 2021Pooled it
- Efficacy and safety of rapid tests to guide antibiotic prescriptions for sore throat.The Cochrane database of systematic reviews · 2020Pooled it
- Health care costs of influenza-related episodes in high income countries: A systematic review.PloS one · 2018Pooled it
- Trial
- Rapid Respiratory Microbiological Point-of-Care Testing and Antibiotic Use in Primary Care: A Randomized Clinical Trial.JAMA internal medicine · 2026Trial
- Use of the FebriDx® host-response point-of-care test may reduce antibiotic use for respiratory tract infections in primary care: a mixed-methods feasibility study.The Journal of antimicrobial chemotherapy · 2024Trial
- Effects of a multimodal intervention in primary care to reduce second line antibiotic prescriptions for urinary tract infections in women: parallel, cluster randomised, controlled trial.BMJ (Clinical research ed.) · 2023Trial
- Clinical presentation, microbiological aetiology and disease course in patients with flu-like illness: a post hoc analysis of randomised controlled trial data.The British journal of general practice : the journal of the Royal College of General Practitioners · 2022Trial
- Alterations of human skin microbiome and expansion of antimicrobial resistance after systemic antibiotics.Science translational medicine · 2021Trial
- Pelargonium sidoides root extract for the treatment of acute cough due to lower respiratory tract infection in adults: a feasibility double-blind, placebo-controlled randomised trial.BMC complementary medicine and therapies · 2021Trial
- Biomarker-guided antibiotic stewardship in suspected ventilator-associated pneumonia (VAPrapid2): a randomised controlled trial and process evaluation.The Lancet. Respiratory medicine · 2020Trial
- Trial
- The decision-making process in general practice of when to use antibiotics to treat acute rhinosinusitis.Scandinavian journal of primary health care · 2026Article
- General practitioners' type of remuneration and antibiotic prescriptions. An analysis of patient switches using nationwide registry data.Scandinavian journal of primary health care · 2026Article
- Consultations, (antibiotic) prescriptions, and productivity losses of patients with community-acquired respiratory tract infection: country-specific findings from the PRUDENCE trial.The European journal of health economics : HEPAC : health economics in prevention and care · 2026Article
63 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Objectives: Previous work based on guidelines and expert opinion identified 'ideal' prescribing proportions-the overall proportion of consultations that should result in an antibiotic prescription-for common infectious conditions. Here, actual condition-specific prescribing proportions in primary care in England were compared with ideal prescribing proportions identified by experts. Methods: All recorded consultations for common infectious conditions (cough, bronchitis, exacerbations of asthma or chronic obstructive pulmonary disease, sore throat, rhinosinusitis, otitis media, lower respiratory tract infection, upper respiratory tract infection, influenza-like illness, urinary tract infection, impetigo, acne, gastroenteritis) for 2013-15 were extracted from The Health Improvement Network (THIN) database. The proportions of consultations resulting in an antibiotic prescription were established, concentrating on acute presentations in patients without relevant comorbidities. These actual prescribing proportions were then compared with previously established 'ideal' proportions by condition. Results: For most conditions, substantially higher proportions of consultations resulted in an antibiotic prescription than was deemed appropriate according to expert opinion. An antibiotic was prescribed in 41% of all acute cough consultations when experts advocated 10%. For other conditions the proportions were: bronchitis (actual 82% versus ideal 13%); sore throat (actual 59% versus ideal 13%); rhinosinusitis (actual 88% versus ideal 11%); and acute otitis media in 2- to 18-year-olds (actual 92% versus ideal 17%). Substantial variation between practices was found. Conclusions: This work has identified substantial overprescribing of antibiotics in English primary care, and highlights conditions where this is most pronounced, particularly in respiratory tract conditions.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.