Prescribing fewer antibiotics for respiratory tract infections may be associated with a slight increase in the incidence of treatable pneumonia and peritonsillar abscess, according to a study published in the BMJ.

However, even after antibiotic prescriptions were substantially reduced, the incidence of pneumonia and peritonsillar abscess increased by only a small amount.

The study, led by Martin C. Gulliford, FFPH, MA, from the Division of Health and Social Care Research at King’s College London, included registered patients from 610 general practices in the United Kingdom for a total of 45.5 million person years of follow-up from 2005 to 2014. The researchers calculated the standardized proportion of respiratory tract infection consultations in which antibiotics were prescribed for each practice; they also determined the rate of antibiotic prescriptions for respiratory tract infections per 1,000 registered patients. The primary outcomes were incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre’s syndrome.

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From 2005 to 2014, the proportion of respiratory tract infection consultations with antibiotics prescribed decreased from 53.9% to 50.5% in men and from 54.5% to 51.5% in women. New cases of meningitis decreased annually by 5.3%, cases of mastoiditis decreased annually by 4.6%, and cases of peritonsillar abscess decreased annually by 1.0%. New cases of pneumonia increased annually by 0.4%.

The practices in the lowest quarter of antibiotic prescribing rates had higher rates of pneumonia and peritonsillar abscess when compared with practices in the highest quarter. The researchers determined that a 10% reduction in antibiotics prescribed resulted in an adjusted relative risk increase of 12.8% for pneumonia and 9.9% for peritonsillar abscess.

“If a general practice with an average list size of 7000 patients reduces the proportion of RTI consultations with antibiotics prescribed by 10%, then it might observe 1.1 (95% confidence interval 0.6 to 1.5) more cases of pneumonia each year and 0.9 (0.5 to 1.3) more cases of peritonsillar abscess each decade,” wrote the researchers.

Incidence rates for mastoiditis, empyema, meninigitis, intracranial abscess, and Lemierre’s syndrome were comparable at all practices.


  1. Gulliford MC, Moore MV, Little P, et al. Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records. BMJ. 2016 July 4. doi:10.1136/bmj.i3410 [Epub ahead of print]