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Cohort study
General practices that reduce antibiotic prescribing for self-limiting respiratory tract infections by 10% can expect to see one extra patient with pneumonia each year and one peritonsillar abscess each decade
  1. Oliver van Hecke,
  2. Chris C Butler
  1. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to : Professor Chris C Butler, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK; christopher.butler{at}

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Unnecessary antibiotic use in the community is a major driver for the development of resistant bacterial carriage.1 Despite the self-limiting nature of most acute respiratory tract infections (RTIs),2 a substantial proportion of consultations in the community result in an antibiotic prescription.3 Clinicians over-prescribe antibiotics partly because non-antibiotic management might result in more complications, and because more serious infections can initially present innocuously.4 This study explored whether the incidence of specific infective complications was higher in patients registered with general practices that prescribed fewer antibiotics for self-limiting RTIs.


This was a retrospective observational cohort study using routinely collected data from 2005 to 2014 in the Clinical Practice Research Datalink (CPRD). The complications included incident events of diagnoses of pneumonia, peritonsillar abscess, mastoiditis, …

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  • Competing interests CCB has carried out studies of antibiotic use in the community and holds several grants in the field.

  • Provenance and peer review Commissioned; internally peer reviewed