General practice antibiotic prescriptions attributable to respiratory syncytial virus by age and antibiotic class: an ecological analysis of the English population
Miller L., Beaney T., Hope R., Cunningham M., Robotham J., Pouwels K., Costelloe CE.
Background Respiratory syncytial virus (RSV) may contribute to a substantial volume of antibiotic prescriptions in primary care. However, data on the type of antibiotics prescribed for such infections is only available for children <5 years in the UK. Understanding the contribution of RSV to antibiotic prescribing would facilitate predicting the impact of RSV preventative measures on antibiotic use and resistance. Objectives To estimate the proportion of antibiotic prescriptions in English general practice attributable to RSV by age and antibiotic class. Methods Generalised additive models examined associations between weekly counts of general practice antibiotic prescriptions and laboratory-confirmed respiratory infections from 2015 to 2018, adjusting for temperature, practice holidays and remaining seasonal confounders. We used general practice records from the Clinical Practice Research Datalink and microbiology tests for RSV, influenza, rhinovirus, adenovirus, parainfluenza, human Metapneumovirus, Mycoplasma pneumoniae and Streptococcus pneumoniae from England’s Second Generation Surveillance System. Results An estimated 2.1% of antibiotics were attributable to RSV, equating to an average of 640,000 prescriptions annually. Of these, adults ≥75 years contributed to the greatest volume, with an annual average of 149,078 (95% credible interval: 93,733-206,045). Infants 6-23 months had the highest average annual rate at 6,580 prescriptions per 100,000 individuals (95% credible interval: 4,522-8,651). Most RSV-attributable antibiotic prescriptions were penicillins, macrolides or tetracyclines. Adults ≥65 years had a wider range of antibiotic classes associated with RSV compared to younger age groups. Conclusions Interventions to reduce the burden of RSV, particularly in older adults, could complement current strategies to reduce antibiotic use in England.