Delayed Antibiotic Prescribing and Associated Antibiotic Consumption in Adults with Acute Cough

Overview

Journal Br J Gen Pract

Specialty Public Health

Date 2012 Sep 6

PMID 22947585

Citations 26

Authors

Nick A Francis

David Gillespie

Jacqueline Nuttall

Kerenza Hood

Paul Little

Theo Verheij

Herman Goossens

Samuel Coenen

Christopher C Butler

Affiliations

Soon will be listed here.

Abstract

Background: Delayed antibiotic prescribing is promoted as a strategy to reduce antibiotic consumption, but its use and its effect on antibiotic consumption in routine care is poorly described.

Aim: To quantify delayed antibiotic prescribing in adults presenting in primary care with acute cough/lower respiratory tract infection (LRTI), duration of advised delay, consumption of delayed antibiotics, and factors associated with consumption.

Design And Setting: Prospective observational cohort in general practices in 14 primary care networks in 13 European countries.

Method: GPs recorded clinical features and antibiotic prescribing for adults presenting with an acute infective illness with cough as the dominant symptom. Patients recorded their consumption of antibiotics from any source during the 28-day follow up.

Results: Two hundred and ten (6.3%) of 3368 patients with usable consultation data were prescribed delayed antibiotics. The median recommended delay period was 3 days. Seventy-five (44.4%) of the 169 with consumption data consumed the antibiotic course and a further 18 (10.7%) took another antibiotic during the study period. 50 (29.6%) started their delayed course on the day of prescription. Clinician diagnosis of upper respiratory tract/viral infection and clinician's perception of patient's wanting antibiotics were associated with less consumption of the delayed prescription. Patient's wanting antibiotics was associated with greater consumption.

Conclusion: Delayed antibiotic prescribing was used infrequently for adults presenting in general practice with acute cough/LRTI. When used, the effect on antibiotic consumption was less than found in most trials. There are opportunities for standardising the intervention and promoting wider uptake.

Citing Articles

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References

Peters S, Rowbotham S, Chisholm A, Wearden A, Moschogianis S, Cordingley L . Managing self-limiting respiratory tract infections: a qualitative study of the usefulness of the delayed prescribing strategy. Br J Gen Pract. 2011; 61(590):e579-89. PMC: 3162181. DOI: 10.3399/bjgp11X593866. View

Little P, Williamson I, Warner G, Gould C, Gantley M, Kinmonth A . Open randomised trial of prescribing strategies in managing sore throat. BMJ. 1997; 314(7082):722-7. PMC: 2126131. DOI: 10.1136/bmj.314.7082.722. View

Little P, Gould C, Williamson I, Moore M, Warner G, Dunleavey J . Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media. BMJ. 2001; 322(7282):336-42. PMC: 26576. DOI: 10.1136/bmj.322.7282.336. View

Spurling G, Del Mar C, Dooley L, Foxlee R . Delayed antibiotics for symptoms and complications of respiratory infections. Cochrane Database Syst Rev. 2004; (4):CD004417. DOI: 10.1002/14651858.CD004417.pub2. View

Butler C, Hood K, Kelly M, Goossens H, Verheij T, Little P . Treatment of acute cough/lower respiratory tract infection by antibiotic class and associated outcomes: a 13 European country observational study in primary care. J Antimicrob Chemother. 2010; 65(11):2472-8. DOI: 10.1093/jac/dkq336. View

Jakobsen K, Melbye H, Kelly M, Ceynowa C, Molstad S, Hood K . Influence of CRP testing and clinical findings on antibiotic prescribing in adults presenting with acute cough in primary care. Scand J Prim Health Care. 2010; 28(4):229-36. PMC: 3444795. DOI: 10.3109/02813432.2010.506995. View

Fischer T, Fischer S, Kochen M, Hummers-Pradier E . Influence of patient symptoms and physical findings on general practitioners' treatment of respiratory tract infections: a direct observation study. BMC Fam Pract. 2005; 6(1):6. PMC: 550651. DOI: 10.1186/1471-2296-6-6. View

Siegel R, Kiely M, Bien J, Joseph E, Davis J, Mendel S . Treatment of otitis media with observation and a safety-net antibiotic prescription. Pediatrics. 2003; 112(3 Pt 1):527-31. DOI: 10.1542/peds.112.3.527. View

Butler C, Hood K, Verheij T, Little P, Melbye H, Nuttall J . Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries. BMJ. 2009; 338:b2242. PMC: 3272656. DOI: 10.1136/bmj.b2242. View

10.

Little P . Delayed prescribing of antibiotics for upper respiratory tract infection. BMJ. 2005; 331(7512):301-2. PMC: 1183117. DOI: 10.1136/bmj.331.7512.301. View

11.

Dowell J, Pitkethly M, Bain J, Martin S . A randomised controlled trial of delayed antibiotic prescribing as a strategy for managing uncomplicated respiratory tract infection in primary care. Br J Gen Pract. 2001; 51(464):200-5. PMC: 1313951. View

12.

Butler C, Kelly M, Hood K, Schaberg T, Melbye H, Serra-Prat M . Antibiotic prescribing for discoloured sputum in acute cough/lower respiratory tract infection. Eur Respir J. 2011; 38(1):119-25. DOI: 10.1183/09031936.00133910. View

13.

Edwards M, Dennison J, Sedgwick P . Patients' responses to delayed antibiotic prescription for acute upper respiratory tract infections. Br J Gen Pract. 2004; 53(496):845-50. PMC: 1314726. View

14.

Gulliford M, Latinovic R, Charlton J, Little P, van Staa T, Ashworth M . Selective decrease in consultations and antibiotic prescribing for acute respiratory tract infections in UK primary care up to 2006. J Public Health (Oxf). 2009; 31(4):512-20. PMC: 2781723. DOI: 10.1093/pubmed/fdp081. View

15.

Cates C . Delayed prescriptions in primary care. Br J Gen Pract. 2004; 53(496):836-7. PMC: 1314724. View

16.

Little P, Rumsby K, Kelly J, Watson L, Moore M, Warner G . Information leaflet and antibiotic prescribing strategies for acute lower respiratory tract infection: a randomized controlled trial. JAMA. 2005; 293(24):3029-35. DOI: 10.1001/jama.293.24.3029. View

17.

Sharland M, Kendall H, Yeates D, Randall A, Hughes G, Glasziou P . Antibiotic prescribing in general practice and hospital admissions for peritonsillar abscess, mastoiditis, and rheumatic fever in children: time trend analysis. BMJ. 2005; 331(7512):328-9. PMC: 1183132. DOI: 10.1136/bmj.38503.706887.AE1. View

18.

Arroll B, Goodyear-Smith F, Thomas D, Kerse N . Delayed antibiotic prescriptions: what are the experiences and attitudes of physicians and patients?. J Fam Pract. 2002; 51(11):954-9. View

19.

Stanton N, Hood K, Kelly M, Nuttall J, Gillespie D, Verheij T . Are smokers with acute cough in primary care prescribed antibiotics more often, and to what benefit? An observational study in 13 European countries. Eur Respir J. 2009; 35(4):761-7. DOI: 10.1183/09031936.00168409. View

20.

Wood J, Butler C, Hood K, Kelly M, Verheij T, Little P . Antibiotic prescribing for adults with acute cough/lower respiratory tract infection: congruence with guidelines. Eur Respir J. 2011; 38(1):112-8. DOI: 10.1183/09031936.00145810. View