1. Reduced effectiveness among β-lactam antibiotics: a population-based cohort study in primary care in Italy
- Author
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Francesco Lapi, Claudio Cricelli, Ettore Marconi, Alessandro Rossi, Erik Lagolio, Serena Pecchioli, and Ercole Concia
- Subjects
0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,medicine.drug_class ,030106 microbiology ,Antibiotics ,beta-Lactams ,THERAPY ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Community-acquired pneumonia ,Internal medicine ,medicine ,Humans ,FAILURE ,Pharmacology (medical) ,RATES ,030212 general & internal medicine ,Retrospective Studies ,Pharmacology ,Primary Health Care ,Proportional hazards model ,business.industry ,Hazard ratio ,COMMUNITY-ACQUIRED PNEUMONIA ,Retrospective cohort study ,Amoxicillin ,medicine.disease ,Anti-Bacterial Agents ,Infectious Diseases ,Italy ,DISEASES ,Ceftriaxone ,COMMUNITY-ACQUIRED PNEUMONIA, RESISTANCE, DISEASES, THERAPY, FAILURE, RATES ,Amoxicillin-Potassium Clavulanate Combination ,business ,RESISTANCE ,medicine.drug - Abstract
Background There are few data comparing the relative effectiveness of the individual β-lactams. Objectives To quantify the reduced effectiveness, defined as switching to a different antibiotic being prescribed for the same indication, among new users of β-lactam antibiotics in primary care. Methods A retrospective cohort study was conducted using the Health Search Database, an Italian primary care data source. Patients newly prescribed with β-lactams for a specific indication between 1 January 2013 and 31 December 2017 were identified. A switch to a different antibiotic for the same indication occurring during a 30day follow-up was the study outcome. Cox regression was adopted to assess the risk of switching between the different β-lactams. Results Among 178 256 patients newly treated with β-lactam antibiotics, 1172 (0.65%) switched to a different antibiotic. Amoxicillin/clavulanate (co-amoxiclav: n = 104 891) and amoxicillin (n = 21 699) were the most frequently prescribed β-lactams. The other antibiotics showed significantly higher risk of switching when compared with co-amoxiclav for lower respiratory tract [e.g. ceftriaxone, hazard ratio (HR): 1.6, 95% CI: 1.2–2.0], dental [e.g. amoxicillin, HR: 4.2, 95% CI: 2.9–5.9], and middle ear infections [e.g. amoxicillin, HR: 1.8, 95% CI: 1.1–2.7]. The same results were gathered when parenteral formulations were excluded. Conclusions The prevalence of reduced effectiveness of newly prescribed β-lactam antibiotics was lower than 1%. Specifically, the rate of switch to another antibiotic, when it was prescribed to treat low respiratory tract, dental, and middle ear infections, was lower among users of co-amoxiclav than those prescribed with other β-lactams.
- Published
- 2021