The role of evidence in the decline of antibiotic use for common respiratory infections in primary care

Cosby, Jarold; Francis, Nick; Butler, Christopher Collett

doi:10.1016/s1473-3099(07)70263-3

Cited by 58 publications

(54 citation statements)

References 84 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Concerns regarding the optimum rate of antibiotic prescribing have been previously raised. 21 A much larger prospective study is needed both to replicate the findings and to rule out the possibility of harm.…”

Section: Strengths and Limitations Of The Studymentioning

confidence: 99%

“…10,22 This effect is not confined to the UK and changes have been linked to improved evidence of marginal benefit of prescribing. 21 The effect of prescribing on beliefs in the effectiveness of antibiotics, the intention to consult in the future, and actual consultation behaviour are all potential mediators of reduced consultation rates. The effect of prescribing on illness beliefs, 8 and future illness behaviour 9 has been previously described by this group for URTI.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

See 1 more Smart Citation

Effect of antibiotic prescribing strategies and an information leaflet on longer-term reconsultation for acute lower respiratory tract infection

Moore¹,

Little²,

Rumsby³

et al. 2009

Br J Gen Pract

View full text Add to dashboard Cite

Limited evidence suggests that delayed prescribing may influence future consultation behaviour. AimTo assess the effects of antibiotic prescribing strategy on reconsultation in the year following presentation with acute lower respiratory tract infection (LRTI). Design of studyBalanced factorial randomised trial. SettingPrimary care. MethodEight hundred and seven subjects, aged ≥3 years, had acute illness presenting with cough as the main symptom, plus at least one symptom or sign from sputum, chest pain, dyspnoea or wheeze. The subjects were randomised to one of three prescribing strategies (antibiotics, delayed antibiotic, no antibiotic) and a leaflet. Prior antibiotic use and reconsultation were assessed by medical record review. ResultsPatients who had been prescribed antibiotic for cough in the previous 2 years were much more likely to reconsult (incidence rate ratio [IRR] = 2.55, 95% confidence interval [CI] = 1.62 to 4.01) and use of a delayed prescription strategy is associated with reduced reconsultation in this group. In those with prior antibiotic exposure, there was a 34% reduction in consultation rate in the no antibiotic group (IRR = 0.66, 0.30 to 1.44, P = 0.295) and a 78% reduction for the delayed antibiotic group (IRR = 0.22, 0.10 to 0.49, P<0.001) when compared with those given immediate antibiotics. This effect was not observed in patients who had not been prescribed antibiotics in the previous 2 years; there was no reduction in consultations in the no antibiotic group (IRR = 1.23, 0.79 to 1.92, P = 0.358) or the delayed antibiotic group (1.19, 0.78 to 1.80, P = 0.426). There was an increase in consultation rate with an information leaflet (IRR = 1.27, 0.86 to 1.87, P = 0.229). Past attendance with cough, or past attendance with other respiratory illness and smoking, also predicted reconsultation with cough. ConclusionDelayed antibiotic prescribing for LRTI appears effective in modifying reconsultation behaviour, particularly in those with a prior history of antibiotic prescription for LRTI. Keywordsanti-bacterial agents; primary health care; referral and consultation; respiratory tract infections. INTRODUCTIONPreliminary evidence in acute sore throat suggests that delayed prescribing may influence future consultation behaviour.Those with a recent history of antibiotic prescribing were much more than twice as likely to reconsult in the year following the index consultation with acute lower respiratory infection (LRTI). They showed substantial (78%) reduction in consultation following delayed prescribing compared with immediate prescribing.Over time, utilising a delayed prescribing strategy is likely to result in sustained reduction in consultation for LRTI. BackgroundAcute respiratory illness is the most common condition managed in primary care, and antibiotics are widely prescribed for LRTI despite limited evidence of benefit.

show abstract

Section: Strengths and Limitations Of The Studymentioning

confidence: 99%

Section: Comparison With Existing Literaturementioning

confidence: 99%

Effect of antibiotic prescribing strategies and an information leaflet on longer-term reconsultation for acute lower respiratory tract infection

Moore¹,

Little²,

Rumsby³

et al. 2009

Br J Gen Pract

View full text Add to dashboard Cite

show abstract

“…[10][11][12] Both the decision to prescribe and choice of antibiotic are complex, and influenced by both clinical and non-clinical factors. [13][14][15][16][17][18][19][20] Most studies have focused on prescribing for respiratory tract infections (RTIs). 17,18,21 Some studies have considered antibiotic prescribing more generally in children but there are few studies based in UK general practice.…”

mentioning

confidence: 99%

Clinical predictors of antibiotic prescribing for acutely ill children in primary care: an observational study

O’Brien¹,

Bellis

Kelson

et al. 2015

Br J Gen Pract

Self Cite

View full text Add to dashboard Cite

show abstract

“…Feasible clinical strategies are needed for more effective targeting of antibiotic treatment to those who will receive meaningful benefit in order to contain antimicrobial resistance, reduce cost, promote self-care and reduce unnecessary risk from sideeffects [4,5]. Physicians commonly ask their patients about the colour of their sputum and how unwell they are feeling to inform their decision of whether or not to prescribe an antibiotic for acute cough, based on the assumption that purulence is more likely to reflect a bacterial cause and predict improved outcomes from antibiotics [6][7][8].…”

mentioning

confidence: 99%

Antibiotic prescribing for discoloured sputum in acute cough/lower respiratory tract infection

Butler¹,

Kelly²,

Hood³

et al. 2011

European Respiratory Journal

View full text Add to dashboard Cite

We investigated whether discoloured sputum and feeling unwell were associated with antibiotic prescription and benefit from antibiotic treatment for acute cough/lower respiratory tract infection (LTRI) in a prospective study of 3,402 adults in 13 countries.A two-level model investigated the association between producing discoloured sputum or feeling generally unwell and an antibiotic prescription. A three-level model investigated the association between an antibiotic prescription and symptom resolution.Patients producing discoloured sputum were prescribed antibiotics more frequently than those not producing sputum (OR 3.2, 95% CI 2.1-5.0), unlike those producing clear/white sputum (OR 0.95, 95% CI 0.61-1.48). Antibiotic prescription was not associated with a greater rate or magnitude of symptom score resolution (as measured by a 13-item questionnaire completed by patients each day) among those who: produced yellow (coefficient 0.00; p50.68) or green (coefficient -0.01; p50.11) sputum; reported any of three categories of feeling unwell; or produced discoloured sputum and felt generally unwell (coefficient -0.01; p50.19).Adults with acute cough/LRTI presenting in primary care settings with discoloured sputum were prescribed antibiotics more often compared to those not producing sputum. Sputum colour, alone or together with feeling generally unwell, was not associated with recovery or benefit from antibiotic treatment.

show abstract

The role of evidence in the decline of antibiotic use for common respiratory infections in primary care

Cited by 58 publications

References 84 publications

Effect of antibiotic prescribing strategies and an information leaflet on longer-term reconsultation for acute lower respiratory tract infection

Effect of antibiotic prescribing strategies and an information leaflet on longer-term reconsultation for acute lower respiratory tract infection

Clinical predictors of antibiotic prescribing for acutely ill children in primary care: an observational study

Antibiotic prescribing for discoloured sputum in acute cough/lower respiratory tract infection

Contact Info

Product

Resources

About