Promoting appropriate antibiotic prescribing: recognition in Lancet Respiratory Medicine

A simple scoring system can predict the chances of children with a respiratory tract infection being admitted to hospital, thereby helping to target antibiotics more appropriately. This important finding is highlighted in a commentary written by Chris Winchester, Managing Director of Oxford PharmaGenesis, and colleagues, which is published today in Lancet Respiratory Medicine. The scoring system was developed and validated in a study of over 8000 children with respiratory tract infection, of whom 37% were prescribed an antibiotic and 1% were admitted to hospital. Seven signs and symptoms that can be easily assessed in primary care predicted the risk of hospital admission with remarkable accuracy. The resulting scoring system has the potential to reduce antibiotic prescription in primary care by helping to target antibiotics where they are needed most.

Respiratory tract infection is the most common reason for children in the UK to consult in primary care. Primary care physicians have the difficult job of distinguishing self-limiting infections that can be managed at home from those that are potentially life-threatening. By providing clear guidance on where to target antibiotics, the scoring system has the potential to form the basis for shared decision-making in a highly charged area, say Chris Winchester and co-authors, REG founder Professor David Price from the University of Aberdeen and the Pragmatic Research Institute in Singapore and Alison Chisholm from the Respiratory Effectiveness Group in Cambridge, UK.

Chris’ collaboration with Professor Price and colleagues dates back to 2001 and has included a role as an honorary clinical research fellow in the Centre for Academic Primary Care at the University of Aberdeen. They first highlighted the potential for policies that cut antibiotic prescribing to adversely affect patient health in an article published in 2004. A subsequent study funded by the International Primary Care Respiratory Group and published in 2009 showed that antibiotic prescribing for chest infections is associated with a decreased risk of pneumonia admissions and reduced mortality. Oxford PharmaGenesis encourages HealthScience communications professionals to develop significant expertise in their fields that can help to advance the practice of evidence-based medicine and improve patient care.

Further reading

Winchester CC, Chisholm A, Price D. A practical tool for primary care antimicrobial stewardship in children.  Lancet Respir Med 2016; doi:10.1016/S2213-2600(16)30272-7.

Hay A, Redmond NM, Turnbull S, Christensen H, Thornton H, Little P, Thompson M, Delaney B, Lovering A, Muir P, Leeming J, Vipond B, Stuart B, Peters T, Blair P. Development and internal validation of a clinical rule to improve antibiotic use in children presenting to primary care with acute respiratory tract infection and cough: the ‘TARGET’ prognostic cohort study.  Lancet Respir Med 2016; doi:10.1016/S2213-2600(16)30223-5.

Winchester CC, Macfarlane TV, Thomas M, Price D. Antibiotic prescribing and outcomes of lower respiratory tract infection in UK primary care.  Chest 2009;135:1163–72.

Price DB, Honeybourne D, Little P, Mayon-White RT, Read RC, Thomas M, Wale MC, FitzGerald P, Weston AR, Winchester CC. Community-acquired pneumonia mortality: a potential link to antibiotic prescribing trends in general practice.  Respir Med 2004;98: 17–24.

Zoe Mitchell


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