Background Respiratory syncytial virus (RSV) may contribute to a substantial volume of antibiotic prescriptions in primary care. However, data on the type of antibiotics prescribed for such infections is only available for children <5 years in the UK. Understanding the contribution of RSV to antibiotic prescribing would facilitate predicting the impact of RSV preventative measures on antibiotic use and resistance.

Objectives To estimate the proportion of antibiotic prescriptions in English general practice attributable to RSV by age and antibiotic class.

Methods Generalised additive models examined associations between weekly counts of general practice antibiotic prescriptions and laboratory-confirmed respiratory infections from 2015 to 2018, adjusting for temperature, practice holidays and remaining seasonal confounders. We used general practice records from the Clinical Practice Research Datalink and microbiology tests for RSV, influenza, rhinovirus, adenovirus, parainfluenza, human Metapneumovirus, Mycoplasma pneumoniae and Streptococcus pneumoniae from England’s Second Generation Surveillance System.

Results An estimated 2.1% of antibiotics were attributable to RSV, equating to an average of 640,000 prescriptions annually. Of these, adults ≥75 years contributed to the greatest volume, with an annual average of 149,078 (95% credible interval: 93,733-206,045). Infants 6-23 months had the highest average annual rate at 6,580 prescriptions per 100,000 individuals (95% credible interval: 4,522-8,651). Most RSV-attributable antibiotic prescriptions were penicillins, macrolides or tetracyclines. Adults ≥65 years had a wider range of antibiotic classes associated with RSV compared to younger age groups.

Conclusions Interventions to reduce the burden of RSV, particularly in older adults, could complement current strategies to reduce antibiotic use in England.

The authors have declared no competing interest.

https://www.cprd.com/approved-studies/respiratory-syncytial-virus-rsv-infections-england-estimating-burden-antibiotic

This research was supported by the Medical Research Foundation National PhD Training Programme in Antimicrobial Resistance Research (scholarship MRF-145-0004-TPG-AVISO to L.M). C.E.C is supported by the National Institute for Health and Care Research (NIHR) Royal Marsden/Institute of Cancer Research Biomedical Research Centre and a personal NIHR fellowship award (grant 2016-10-95). K.B.P and J.V.R are both supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford in partnership with the UK Health Security Agency (UKHSA) (NIHR200915). T.B is supported by a fellowship from the Wellcome Trust. The interpretation and conclusions contained in this study are those of the authors alone, and not necessarily those of the Medical Research Foundation, NIHR, Department of Health and Social Care, UKHSA or CPRD.

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The Independent Scientific Advisory Committee of the Clinical Practice Research Datalink (CPRD) gave ethical approval for this work (protocol 20_000283) and the Imperial College Research Ethics Committee of Imperial College London gave ethical approval for this work (reference number 21IC6607).

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