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Table 3 Factors associated with an antibiotic prescription issued within 3 days of ALRTIa episode in patients with asthmab

From: Use of antibiotics and asthma medication for acute lower respiratory tract infections in people with and without asthma: retrospective cohort study

 

No antibiotics, n (%)

Antibiotics, n (%)

Univariate analysis

Full model

OR (95% CI)

p-value

OR (95% CI)

p-value

  

2052 (18.9)

8787 (81.1)

    

Demographic factors

 Gender

Male

652 (31.8)

3127 (35.6)

1 (ref)

 

1 (ref)

 

Female

1400 (68.2)

5659 (64.4)

0.84 (0.76, 0.94)

< 0.001

0.75 (0.63, 0.90)

0.002

 Age at ALRTI (years) c

per SD

  

0.94 (0.89, 0.99)

0.01

1.02 (0.93, 1.12)

0.64

 IMD quintile

1 (Least)

390 (19.0)

1765 (20.1)

1 (ref)

 

1 (ref)

 

2

363 (17.7)

1774 (20.2)

1.09 (0.92, 1.29)

 

1.27 (0.99, 1.65)

 

3

418 (20.4)

1733 (19.7)

0.94 (0.79, 1.11)

 

1.33 (1.02, 1.72)

 

4

424 (20.7)

1723 (19.6)

0.91 (0.76, 1.08)

 

1.26 (0.97, 1.64)

 

5 (Most)

457 (22.3)

1792 (20.4)

0.89 (0.74, 1.06)

0.17

1.52 (1.15, 1.99)

0.05

 Current smoking status

Never

826 (40.3)

3415 (38.9)

1 (ref)

 

1 (ref)

 

Current

1007 (49.1)

3857 (43.9)

0.93 (0.83, 1.03)

 

1.04 (0.87, 1.25)

 

Previous

219 (10.7)

1515 (17.2)

1.71 (1.45, 2.02)

< 0.001

0.94 (0.74, 1.19)

0.69

Clinical factors

 Season of infection

Summer

786 (38.3)

3113 (35.4)

1 (ref)

 

1 (ref)

 

Winder

1266 (61.7)

5674 (64.6)

1.13 (1.02, 1.25)

0.02

1.14 (0.96, 1.34)

0.13

 Prescribed asthma medication d

No

1758 (85.7)

4600 (52.4)

1 (ref)

 

1 (ref)

 

Yes

294 (14.3)

4187 (47.7)

5.76 (5.04, 6.59)

< 0.001

1.44 (1.32, 1.57)

< 0.001

 Number of ALRTI in prior 12 months

0

1214 (59.2)

7932 (90.3)

1 (ref)

 

1 (ref)

 

1

592 (28.9)

727 (8.3)

0.18 (0.16, 0.21)

 

0.52 (0.41, 0.67)

 

2+

246 (12.0)

128 (1.5)

0.07 (0.06, 0.09)

< 0.001

0.25 (0.17, 0.39)

< 0.001

 Multimorbidity score e

0

1135 (55.3)

2518 (28.7)

1 (ref)

 

1 (ref)

 

1

307 (15.0)

2279 (25.9)

3.34 (2.89, 3.85)

 

1.13 (0.90, 1.41)

 

2

221 (10.8)

1592 (18.1)

3.29 (2.80, 3.87)

 

1.35 (1.04, 1.76)

 

3+

389 (19.0)

2398 (27.3)

2.85 (2.49, 3.25)

< 0.001

1.05 (0.83, 1.33)

0.12

 Number of antibiotics prescribed in previous 12 months f

0

4045 (72.3)

116 (0.6)

0.001 (0.001, 0.002)

 

0.003 (0.002, 0.004)

 

1

600 (10.7)

7094 (33.5)

1 (ref)

 

1 (ref)

 

2

333 (6.0)

5290 (25.0)

1.26 (1.01, 1.57)

 

1.31 (1.05, 1.64)

 

3+

620 (11.1)

8705 (41.1)

1.06 (0.88, 1.28)

< 0.001

1.28 (1.04, 1.57)

< 0.001

Practice factors

 Practice ALRTI antibiotic rates (per 1000 patients) c

per SD

  

1.55 (1.46, 1.64)

< 0.001

1.47 (1.35, 1.59)

< 0.001

  1. OR Odds ratio, CI Confidence interval, SD Standard deviation, ref reference
  2. Model restricted to participants with complete information on all variables included in the full model. Multi-level logistic regression models were used, with general practice included as a random effect to account for clustering. Coefficients represent the odds of receiving an antibiotic for a unit increase in the exposure of interest. Antibiotics prescribed within 3 days of ALRTI, and includes amoxicillin, doxycycline, clarithromycin, co-amoxiclav, azithromycin, erythromycin, tetracycline, cefalexin, and cefradine
  3. a Acute lower respiratory tract infection
  4. b Defined as ever diagnosed and asthma medication prescribed in the 12 months prior to ALRTI
  5. c Age at index infection and practice ALRTI antibiotic rates standardised (using sample mean values and SDs), and coefficients represent a change in the OR in antibiotic prescribing per 1-standard deviation increment in exposure of interest
  6. d Asthma medication refers to an increase in the dose of current treatment and/or additional asthma medication prescribed compared to the prior month for patients with asthma. Asthma medication includes long- and short-acting β2 agonists, leukotriene receptor antagonists, antimuscarinic bronchodilators, and inhaled and oral corticosteroids
  7. e A list of 37 physical and mental chronic conditions were used to ascertain multimorbidity status in participants at ALRTI diagnosis
  8. f Any antibiotics (BNF chapter 5.1) prescribed in the last 12 months for any condition
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Respiratory Research

ISSN: 1465-993X

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