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Clinical Trial
. 2002 Jan 12;324(7329):91-4.
doi: 10.1136/bmj.324.7329.91.

Reducing antibiotic use for acute bronchitis in primary care: blinded, randomised controlled trial of patient information leaflet

John Macfarlane  1 , William Holmes, Philip Gard, David Thornhill, Rosamund Macfarlane, Richard Hubbard
Affiliations
Clinical Trial

Reducing antibiotic use for acute bronchitis in primary care: blinded, randomised controlled trial of patient information leaflet

John Macfarlane et al. BMJ. .

Abstract

Objective: To assess whether sharing the uncertainty of the value of antibiotics for acute bronchitis in the form of written and verbal advice affects the likelihood of patients taking antibiotics.

Design: Nested, single blind, randomised controlled trial.

Setting: Three suburban general practices in Nottingham Participants: 259 previously well adults presenting with acute bronchitis.

Intervention: In group A, 212 patients were judged by their general practitioner not to need antibiotics that day but were given a prescription to use if they got worse and standard verbal reassurance. Half of them (106) were also given an information leaflet. All patients in group B (47) were judged to need antibiotics and were given a prescription and encouraged to use it.

Main outcome measures: Antibiotic use in the next two weeks. Reconsultation for the same symptoms in the next month.

Results: In group A fewer patients who received the information leaflet took antibiotics compared with those who did not receive the leaflet (49 v 63, risk ratio 0.76, 95% confidence interval 0.59 to 0.97, P=0.04). Numbers reconsulting were similar (11 v 14). In group B, 44 patients took the antibiotics.

Conclusion: Most previously well adults with acute bronchitis were judged not to need antibiotics. Reassuring these patients and sharing the uncertainty about prescribing in a information leaflet supported by verbal advice is a safe strategy and reduces antibiotic use.

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Figures

Figure 1
Figure 1
Information leaflet given to patients
Figure 2
Figure 2
Flow of patients through whole study and nested trial of information leaflet
Figure 3
Figure 3
Kaplan-Meier plot of number of days between consultation and day of taking antibiotics for those who did and did not receive information leaflet
See this image and copyright information in PMC

Comment in

References

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