The Pharmaceutical Journal Vol 267 No 7177 p805-809
8 December 2001

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Falls in antibiotic prescribing linked to pneumonia deaths

Falls in antibiotic prescribing might be linked to increases in deaths caused by pneumonia, say researchers. They point out that the number of prescriptions for antibiotics to treat chest infections in general practice fell from 45 million in 1995 to 35 million in 1999 and that deaths from pneumonia increased over the same period.

"We need to be cautious as associations are not necessarily cause and effect," said Dr Richard Mayon-White, consultant public health physician, Oxford Heath Authority. "But if the results are what they seem, then there is one death from community acquired pneumonia for every 200 fewer GP prescriptions for lower respiratory tract infections." Based on an annual reduction of 500,000 antibiotic prescriptions for chest infections this could represent an additional 2,358 winter pneumonia deaths, he said.

The researchers analysed prescribing and pneumonia records over the past seven years. They found that deaths reported to be caused by pneumonia increased as the incidence of influenza rose. They also observed an upward trend in deaths when the data were adjusted for the incidence of influenza.

Speaking at a press briefing to discuss the results Dr Mike Thomas, a Minchinhampton-based general practitioner, said: "Advice [from the Government] to limit prescribing of antibiotics was driven by the best available evidence. But maybe we need different thresholds for different patients." He added that there was a need to explore the implications of the data to see if advice on antibiotic prescribing should be changed.

The research was presented at the British Thoracic Society’s winter meeting held in London this week.

Pneumonia guidelines Guidelines for the management of community acquired pneumonia have been published by the British Thoracic Society (Thorax 2001;56:iv1).

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