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dc.contributor.authorRodgers, LR
dc.contributor.authorStreeter, AJ
dc.contributor.authorLin, N
dc.contributor.authorHamilton, W
dc.contributor.authorHenley, WE
dc.date.accessioned2021-02-02T13:47:16Z
dc.date.issued2021-01-29
dc.description.abstractBackground Bacterial infections of the upper and lower respiratory tract are a frequent complication of influenza and contribute to the widespread use of antibiotics. Influenza vaccination may help reduce both appropriate and inappropriate prescribing of antibiotics. Electronic health records provide a rich source of information for assessing secondary effects of influenza vaccination. Methods We conducted a retrospective study to estimate effects of influenza vaccine on antibiotic (amoxicillin) prescription in the elderly based on data from the Clinical Practice Research Datalink. The introduction of UK policy to recommend the influenza vaccine to older adults in 2000 led to a substantial increase in uptake, creating a natural experiment. Of 259,753 eligible patients that were unvaccinated in 1999 and aged≥65y by January 2000, 88,519 patients received influenza vaccination in 2000. These were propensity score matched 1:1 to unvaccinated patients. Time-to-amoxicillin was analysed using the Prior Event Rate Ratio (PERR) Pairwise method to address bias from time-invariant measured and unmeasured confounders. A simulation study and negative control outcome were used to help strengthen the validity of results. Results Compared to unvaccinated patients, those from the vaccinated group were more likely to be prescribed amoxicillin in the year prior to vaccination: hazard ratio (HR) 1.90 (95% confidence interval 1.83, 1.98). Following vaccination, the vaccinated group were again more likely to be prescribed amoxicillin, HR 1.64 (1.58,1.71). After adjusting for prior differences between the two groups using PERR Pairwise, overall vaccine effectiveness was 0.86 (0.81, 0.92). Additional analyses suggested that provided data meet the PERR assumptions, these estimates were robust. Conclusions Once differences between groups were taken into account, influenza vaccine had a beneficial effect, lowering the frequency of amoxicillin prescribing in the vaccinated group. Ensuring successful implementation of national programmes of vaccinating older adults against influenza may help contribute to reducing antibiotic resistance.en_GB
dc.identifier.citationVol. 16 (1), article e0246156en_GB
dc.identifier.doi10.1371/journal.pone.0246156
dc.identifier.urihttp://hdl.handle.net/10871/124593
dc.language.isoenen_GB
dc.publisherPublic Library of Science (PLoS)en_GB
dc.rights© 2021 Rodgers et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_GB
dc.titleImpact of influenza vaccination on amoxicillin prescriptions in older adults: A retrospective cohort study using primary care dataen_GB
dc.typeArticleen_GB
dc.date.available2021-02-02T13:47:16Z
dc.descriptionThis is the final version. Available on open access from Public Library of Science via the DOI in this recorden_GB
dc.descriptionData Availability: The data used in this study are owned by the Clinical Practice Research Datalink (www.cprd.com). Researchers can apply for data access from CPRD and submit a study protocol to the Independent Scientific Advisory Committee for approval, using the information outlined in the Methods section of the manuscript. The authors had no special access privileges to the data that future researchers would not have.en_GB
dc.identifier.eissn1932-6203
dc.identifier.journalPLoS ONEen_GB
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/en_GB
dcterms.dateAccepted2021-01-15
rioxxterms.versionVoRen_GB
rioxxterms.licenseref.startdate2021-01-29
rioxxterms.typeJournal Article/Reviewen_GB
refterms.dateFCD2021-02-02T13:46:03Z
refterms.versionFCDVoR
refterms.dateFOA2021-02-02T13:47:23Z
refterms.panelAen_GB


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© 2021 Rodgers et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Except where otherwise noted, this item's licence is described as © 2021 Rodgers et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.