Antibiotics for acute cough: an international observational study of patient adherence in primary care

Abstract

BackgroundNon-adherence to acute antibiotic prescriptions is poorly described and may impact on clinical outcomes, healthcare costs, and interpretation of research. It also results in leftover antibiotics that could be used inappropriately. AimTo describe adherence to antibiotics prescribed for adults presenting with acute cough in primary care, factors associated with non-adherence, and associated recovery. Design and settingProspective observational cohort study in general practices in 14 European primary care networks. MethodGPs recorded patient characteristics and prescribing decisions for adults with acute cough or clinical presentation suggestive of lower respiratory tract infection. Patients recorded antibiotic consumption and daily symptoms over 28 days. Rates of adherence to prescribed antibiotics were assessed, and factors associated with non-adherence were identified using logistic regression. Recovery was compared using a Cox proportional hazards model. ResultsOf 2520 patients prescribed immediate or no antibiotics at the index consultation, 282 (11.2%) took an antibiotic during the follow-up period that was not prescribed for them at the index consultation. Of these, 38.1% had no reconsultations during this period. Prior duration of symptoms, antibiotic treatment duration, antibiotic choice, and primary care network were all associated with adherence. There was no difference in time to recovery between those who were prescribed antibiotics at the index consultation and were fully adherent, partially adherent, and non-adherent. ConclusionNon-adherence to antibiotics for acute cough or lower respiratory tract infection is common. Duration of treatment, choice of antibiotic, and setting were associated with adherence but adherence to treatment was not associated with differences in recovery.

Relationship between Adherence to Oral Antibiotics and Postdischarge Clinical Outcomes among Patients Hospitalized with Staphylococcus aureus Skin Infections

“…These data are consistent with previously reported theoretical constructs and empirical data (14,21,27). Other studies found that poor adherence was associated with a higher number of daily doses of the antibiotic (16,(28)(29)(30), longer antibiotic treatment duration (25,26,28), increasing age, difficulty in buying the antibiotic, duration of treatment, difficulty with ingestion, and satisfaction with the information given by the physician (26). We found that lower adherence was a significant risk factor for poor clinical outcome.…”

“…Few investigations have examined both adherence and clinical outcome for acute infectious diseases. One investigation found no association between clinical outcomes of cough based on patient-reported adherence (25). This lack of association may be based on the fact that antibiotics for bronchitis have no effect on clinical outcome in the majority of patients with bronchitis (31).…”

“…In a French study of 37 patients with a variety of different infections who were being discharged with antibiotics after hospitalization, 43% reported nonadherence to the prescribed antibiotic regimen (15). Another European investigation among patients with acute cough who were prescribed outpatient antibiotics found that 30% of patients reported that they did not consume any antibiotics and that only 44% reported consuming the entire prescribed treatment course (25). Similarly, a study of patients in Portugal reported a rate of adherence to oral antibiotics in community pharmacies of 58% (26).…”

Expectations for consultations and antibiotics for respiratory tract infection in primary care: the RTI clinical iceberg

“…28 GPs in five European countries mentioned patient demand for antibiotics as a driver for prescribing, and supported patient directed educational materials and public campaigns to reduce demand. 29 Antibiotic compliance in acute cough, recorded prospectively in patients from Cardiff and Southampton, was much lower (54% and 58%) 30 than the 75% of participants in this current study who reported finishing their antibiotic course. In contrast, an English telephone survey found that 90% of responders reported finishing their last course; 31 retrospective surveys may not be as reliable as the prospective study.…”

Antibiotic prescribing in relation to diagnoses and consultation rates in Belgium, the Netherlands and Sweden: use of European quality indicators

“…Nevertheless, we should keep in mind that prescribing does not equal consumption, as was clearly shown for antibiotics prescribed for lower RTI by Francis et al. [31], and especially true in high prescribing settings.…”