Unlike the United Kingdom, the United States has boosted its use of broad-spectrum antibiotics for respiratory infections
Research Activities, July 2010, No. 359
Antibiotics are often prescribed for acute nonspecific respiratory infections (ARIs), which are typically caused by viruses that are not susceptible to antibiotics. The large volume and types of antibiotics used in ambulatory settings have contributed to the growing public health problem of drug resistance. The use of so-called broad-spectrum antibiotics, which are effective against a range of pathogens, has also contributed to drug-resistant infections. To combat this problem, both the United States (U.S.) and the United Kingdom (U.K.) have waged public health campaigns to reduce levels of antibiotic prescribing. Overall, antibiotic use has declined both in the U.S. and the U.K. However, while the U.K. continues its low use of broad-spectrum antibiotics, prescribing of these drugs has increased in the U.S., according to a new study.
To determine trends in antibiotic and broad-spectrum antibiotic drug prescribing in the U.K., researchers examined 1.3 million adult and 1.1 million child outpatient ARI visits between 1990 and 2004. For U.K. adults, 71 percent of ARI visits were associated with an antibiotic prescription in 1990, dropping to 59 percent by 2004. For children, the comparable figures were 46 percent in 1990 and 31 percent in 2004. For each successive year, both adults and children experienced a significant decrease in the probability of antibiotic prescribing. With respect to broad-spectrum antibiotic drugs, the prescription rate for adults in 1990 was 3.8 prescriptions per 1,000 person years; by 2004, it fell to 2.9 prescriptions per 1,000 person years. For children, the comparable rates were 5.2 in 1990, dropping to 2.2 in 2004.
In contrast, broad-spectrum antibiotic use for adult and child ARIs in the U.S. more than doubled during the 1990s and continues to increase. The researchers attribute these differences, in part, to differences in health care delivery systems. The U.K. strategy emphasized strong central leadership with explicit priorities emphasizing societal benefit and support by robust financial and regulatory incentives. This study was supported in part by the Agency for Healthcare Research and Quality (HS16946).
See "Reduced antibiotic prescribing for acute respiratory infections in adults and children," by Sharon B. Meropol, M.D., M.S.C.E., Zhen Chen, Ph.D., and Joshua P. Metlay, M.D., Ph.D., in the October 2009 British Journal of General Practice pp. e321-e328.