Int J Antimicrob Agents. 2021 Apr 11:106339. doi: 10.1016/j.ijantimicag.2021.106339. Online ahead of print.
Antibiotic stewardship requires clear insight into antibiotic overuse and into which syndromes lead to prescription. We aim to estimate the proportion of antibiotic prescriptions attributable to acute lower respiratory tract infections (LRTI) during the cold seasons. Using individual data from the French national health insurance, we constructed weekly time series of outpatient antibiotic (beta-lactams and macrolides) prescriptions between January 2010 and December 2017. We also constructed time series of ICD-10 discharge diagnoses from a national network of emergency departments, stratified by specific syndromes (pneumonia, bronchitis, bronchiolitis and influenza-like illness). We modelled and estimated the number of outpatient antibiotic prescriptions attributable to these syndromes, during the cold seasons in France, for the entire population, young children (≤ 5 years) and the elderly (≥ 75 years). LRTIs accounted for 40% (95% confidence interval (95% CI): 29, 52%) of outpatient antibiotic use during the cold seasons for the entire population, including 23% (95% CI: 13, 33%) and 17% (95% CI: 13, 22%) for bacterial and viral infections respectively. In children and the elderly, viral LRTIs were responsible for 38% (95% CI: 31, 46%) and 20% (95% CI: 16, 25%) of outpatient antibiotic use respectively (with bronchiolitis accountable for half in young children). In the entire population and in children respectively, outpatient antibiotic overuse attributable to viral LRTIs was estimated to 289 (95% CI: 221, 374) and 1,588 (95% CI: 1,295, 1,922) prescriptions per 100,000 inhabitants per week. Our results highlight the major role of viral infections in driving antibiotic prescriptions, especially in young children.