BACKGROUND Previous research reported that individuals prescribed antibiotics frequently develop antimicrobial resistance. The objective of this study was to evaluate whether frequent antibiotic use is associated with reduced hospital admissions for infection-related complications. METHODS Population-based cohort study analysing electronic health records from primary care linked to hospital admission records. The study population included patients prescribed a systemic antibiotic, recent record of selected infections and no history of chronic obstructive pulmonary disease. Propensity-matched cohorts were identified based on quintiles of prior antibiotic use in 3 years before. RESULTS A total of 1.8 million patients were included. Repeated antibiotic use was frequent. The highest rates of hospital admissions for infection-related complications were observed shortly after antibiotic start in all prior exposure quintiles. For patients with limited prior antibiotic use, rates then dropped quickly and substantially. In contrast, reductions over time were substantially less in patients with frequent prior antibiotic use, with rates remaining elevated over the following 6 months. In patients without comorbidity comparing the highest to lowest prior exposure quintiles in the Clinical Practice Research Databank, the IRRs were 1.18 [95% CI 0.90-1.55] in the first 3 days after prescription, 1.44 [95% CI 1.14-1.81] in the days 4-30 after and 3.22 [95% CI 2.29-4.53] in the 3-6 months after. CONCLUSIONS Repeated courses of antibiotics, although common practice, may have limited benefit and indicator of adverse outcomes. A potential mechanism is that antibiotics may cause dysbiosis (perturbations of intestinal microbiota), contributing to colonization with resistant bacteria. Antibiotics should be used judiciously and only periodically unless indicated. Antimicrobial stewardship should include activities focusing on the substantive number of patients who repeatedly but intermittently get antibiotics.

中文翻译：

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频繁使用抗生素在降低感染相关住院风险方面的有效性：来自两个大型人群队列的结果。

背景 先前的研究报告称，服用抗生素的个体经常会产生抗微生物药物耐药性。本研究的目的是评估频繁使用抗生素是否与减少感染相关并发症的住院率有关。方法 基于人群的队列研究分析与入院记录相关的初级保健的电​​子健康记录。研究人群包括开具全身抗生素处方的患者、近期选定感染记录和无慢性阻塞性肺病史。倾向匹配的队列是根据 3 年前使用抗生素的五分之一确定的。结果 共纳入 180 万名患者。经常反复使用抗生素。在所有先前暴露的五分位数中，抗生素开始使用后不久观察到的感染相关并发症住院率最高。对于先前使用抗生素有限的患者，比率随后迅速且大幅下降。相比之下，在之前频繁使用抗生素的患者中，随着时间的推移，减少幅度要小得多，在接下来的 6 个月内，这一比例仍然升高。在没有合并症的患者中，比较临床实践研究数据库中最高和最低的既往暴露五分位数，处方后前 3 天的 IRR 为 1.18 [95% CI 0.90-1.55]，在处方后的前 3 天为 1.44 [95% CI 1.14-1.81]后 4-30 天和后 3-6 个月内的 3.22 [95% CI 2.29-4.53]。结论 重复使用抗生素虽然是普遍做法，但其益处和不良结果指标可能有限。一个潜在的机制是抗生素可能导致生态失调（肠道微生物群的扰动），导致耐药细菌定植。除非有指示，否则应谨慎使用抗生素，并且只能定期使用。抗菌药物管理应包括重点关注反复但间歇性使用抗生素的大量患者的活动。