 |
|
Information Leaflet and Antibiotic Prescribing Strategies for Acute Lower Respiratory Tract Infection
A Randomized Controlled Trial
Paul Little, MD;
Kate Rumsby, BA;
Joanne Kelly, BSc;
Louise Watson, PhD;
Michael Moore, MRCGP;
Gregory Warner, MRCGP;
Tom Fahey, MD;
Ian Williamson, MD
JAMA. 2005;293:3029-3035.
Context Acute lower respiratory tract infection is the most common condition treated in primary care. Many physicians still prescribe antibiotics; however, systematic reviews of the use of antibiotics are small and have diverse conclusions.
Objective To estimate the effectiveness of 3 prescribing strategies and an information leaflet for acute lower respiratory tract infection.
Design, Setting, and Patients A randomized controlled trial conducted from August 18, 1998, to July 30, 2003, of 807 patients presenting in a primary care setting with acute uncomplicated lower respiratory tract infection. Patients were assigned to 1 of 6 groups by a factorial design: leaflet or no leaflet and 1 of 3 antibiotic groups (immediate antibiotics, no offer of antibiotics, and delayed antibiotics).
Intervention Three strategies, immediate antibiotics (n = 262), a delayed antibiotic prescription (n = 272), and no offer of antibiotics (n = 273), were prescribed. Approximately half of each group received an information leaflet (129 for immediate antibiotics, 136 for delayed antibiotic prescription, and 140 for no antibiotics).
Main Outcome Measures Symptom duration and severity.
Results A total of 562 patients (70%) returned complete diaries and 78 (10%) provided information about both symptom duration and severity. Cough rated at least "a slight problem" lasted a mean of 11.7 days (25% of patients had a cough lasting  17 days). An information leaflet had no effect on the main outcomes. Compared with no offer of antibiotics, other strategies did not alter cough duration (delayed, 0.75 days; 95% confidence intervals [CI], –0.37 to 1.88; immediate, 0.11 days; 95% CI, –1.01 to 1.24) or other primary outcomes. Compared with the immediate antibiotic group, slightly fewer patients in the delayed and control groups used antibiotics (96%, 20%, and 16%, respectively; P<.001), fewer patients were "very satisfied" (86%, 77%, and 72%, respectively; P = .005), and fewer patients believed in the effectiveness of antibiotics (75%, 40%, and 47%, respectively; P<.001). There were lower reattendances within a month with antibiotics (mean attendances for no antibiotics, 0.19; delayed, 0.12; and immediate, 0.11; P = .04) and higher attendance with a leaflet (mean attendances for no leaflet, 0.11; and leaflet, 0.17; P = .02).
Conclusion No offer or a delayed offer of antibiotics for acute uncomplicated lower respiratory tract infection is acceptable, associated with little difference in symptom resolution, and is likely to considerably reduce antibiotic use and beliefs in the effectiveness of antibiotics.
Author Affiliations: Primary Medical Care Group, University of Southampton, Highfield (Drs Little, Watson, and Williamson, and Mss Rumsby and Kelly); Nightingale Surgery, Romsey, Hants (Dr Warner); Three Swans Surgery, Salisbury (Drs Moore and Fahey), England; and Department of Primary Care, Dundee University, Dundee, Scotland (Dr Fahey).
RELATED LETTERS
Antibiotic Prescribing for Lower Respiratory Tract Infection
Masahito Jimbo
JAMA. 2005;294(24):3089-3090.
EXTRACT
| FULL TEXT
Antibiotic Prescribing for Lower Respiratory Tract Infection—Reply
Paul Little
JAMA. 2005;294(24):3090.
EXTRACT
| FULL TEXT
RELATED ARTICLE
Antibiotic Prescribing for Cough and Symptoms of Respiratory Tract Infection: Do the Right Thing
Mark H. Ebell
JAMA. 2005;293(24):3062-3064.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Recommendations for the assessment and management of cough in children
Shields et al.
Thorax 2008;63:iii1-iii15.
FULL TEXT
Antibiotics and Topical Nasal Steroid for Treatment of Acute Maxillary Sinusitis: A Randomized Controlled Trial
Williamson et al.
JAMA 2007;298:2487-2496.
ABSTRACT
| FULL TEXT
Antibiotics for respiratory tract infections in primary care
Coenen and Goossens
BMJ 2007;335:946-947.
FULL TEXT
Reducing antibiotic prescriptions for acute cough by motivating GPs to change their attitudes to communication and empowering patients: a cluster-randomized intervention study
Altiner et al.
J Antimicrob Chemother 2007;60:638-644.
ABSTRACT
| FULL TEXT
Avoiding antibacterial overuse in primary care
DTB 2007;45:25-29.
ABSTRACT
| FULL TEXT
Impact of Rapid Diagnosis on Management of Adults Hospitalized With Influenza
Falsey et al.
Arch Intern Med 2007;167:354-360.
ABSTRACT
| FULL TEXT
Cost-Effectiveness Analysis of Treatment Options for Acute Otitis Media
Coco
Ann Fam Med 2007;5:29-38.
ABSTRACT
| FULL TEXT
Pandemic flu: clinical management of patients with an influenza-like illness during an influenza pandemic
Lim
Thorax 2007;62:1-46.
FULL TEXT
Delayed prescribing--a sensible approach to the management of acute otitis media.
Little
JAMA 2006;296:1290-1291.
FULL TEXT
A randomised controlled trial of management strategies for acute infective conjunctivitis in general practice
Everitt et al.
BMJ 2006;333:321.
ABSTRACT
| FULL TEXT
Information Leaflet and Antibiotic Prescribing Strategies for Acute Lower Respiratory Tract Infection: A Randomized, Controlled Trial
Adinoff
Pediatrics 2006;118:S54-S55.
ABSTRACT
Community acquired pneumonia in primary care.
Goossens and Little
BMJ 2006;332:1045-1046.
FULL TEXT
Antibiotic Prescribing for Lower Respiratory Tract Infection
Jimbo
JAMA 2005;294:3089-3090.
FULL TEXT
Antibiotic Prescribing for Lower Respiratory Tract Infection
Stapczynski
JAMA 2005;294:2032-2032.
FULL TEXT
Antibiotics aren't needed for lower respiratory tract infection
BMJ 2005;331:.
FULL TEXT
Delayed prescribing of antibiotics for upper respiratory tract infection
Little
BMJ 2005;331:301-302.
FULL TEXT
Delayed Antibiotic Therapy for Respiratory Tract Infections
JWatch Infect. Diseases 2005;2005:7-7.
FULL TEXT
Strategies for Reducing Antibiotic Use in Bronchitis
JWatch General 2005;2005:3-3.
FULL TEXT
What's new in the other general journals
Tonks
BMJ 2005;331:13-14.
FULL TEXT
Antibiotic Prescribing for Cough and Symptoms of Respiratory Tract Infection: Do the Right Thing
Ebell
JAMA 2005;293:3062-3064.
FULL TEXT
|
