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When prescribing for individual patients, the risk of not treating a bacterial infection can seem more important than the risk of prescribing antibiotics. 

Studies that look at the population as a whole, such as Albrich et al 2004, show that more antibiotic use is linked to higher antibiotic resistance. 

In addition to well-recognised adverse drug reactions associated with antibiotics there is growing evidence that reducing antibiotic exposure can protect individual patients from antibiotic resistant infection. 

Evidence for this includes: 

  • A meta-analysis of 25 studies using a review and revise approach to target antibiotic treatment found a reduced relative risk of death by 56%. The authors also found three small studies which looked at stopping antibiotics early when signs of infection are lacking, which all showed trends towards better survival rates (Schuts EC 2016).
  • Two studies comparing the length of antibiotic treatment in nosocomial pneumonia found lower risk of antibiotic resistance in patients treated with short-course therapy (Singh N 2000 and Chastre J 2003).
  • A meta-analysis of studies in primary care found that patients who took antibiotics in the past were much more likely to have a resistant urinary tract or respiratory infections in the future (Costelloe 2010).
  • In secondary care, patients treated with piperacillin-tazobactam or ceftriaxone had greater bowel colonisation by Gram negative bacteria resistant to these agents, during and after treatment (DiNubile et al 2005). Further, the faecal abundance of antibiotic resistant bacteria strongly predicts chance of an antibiotic resistant urinary tract infection (Ruppe 2013).