Information leaflet and antibiotic prescribing strategies for acute lower respiratory tract infection: a randomized controlled trial
- PMID: 15972565
- DOI: 10.1001/jama.293.24.3029
Information leaflet and antibiotic prescribing strategies for acute lower respiratory tract infection: a randomized controlled trial
Abstract
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 > or =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.
Comment in
-
Antibiotic prescribing for cough and symptoms of respiratory tract infection: do the right thing.JAMA. 2005 Jun 22;293(24):3062-4. doi: 10.1001/jama.293.24.3062. JAMA. 2005. PMID: 15972570 No abstract available.
-
No antibiotics needed for lower respiratory infection.J Fam Pract. 2005 Sep;54(9):756. J Fam Pract. 2005. PMID: 16189892 No abstract available.
-
Antibiotic prescribing for lower respiratory tract infection.JAMA. 2005 Oct 26;294(16):2032; author reply 2032. doi: 10.1001/jama.294.16.2032-a. JAMA. 2005. PMID: 16249416 No abstract available.
-
Antibiotic prescribing for lower respiratory tract infection.JAMA. 2005 Dec 28;294(24):3089-90; author reply 3090. doi: 10.1001/jama.294.24.3089. JAMA. 2005. PMID: 16380586 No abstract available.
Similar articles
-
Effect of antibiotic prescribing strategies and an information leaflet on longer-term reconsultation for acute lower respiratory tract infection.Br J Gen Pract. 2009 Oct;59(567):728-34. doi: 10.3399/bjgp09X472601. Br J Gen Pract. 2009. PMID: 19843421 Free PMC article. Clinical Trial.
-
Prescription Strategies in Acute Uncomplicated Respiratory Infections: A Randomized Clinical Trial.JAMA Intern Med. 2016 Jan;176(1):21-9. doi: 10.1001/jamainternmed.2015.7088. JAMA Intern Med. 2016. PMID: 26719947 Clinical Trial.
-
A randomised controlled trial of management strategies for acute infective conjunctivitis in general practice.BMJ. 2006 Aug 12;333(7563):321. doi: 10.1136/bmj.38891.551088.7C. Epub 2006 Jul 17. BMJ. 2006. PMID: 16847013 Free PMC article. Clinical Trial.
-
Delayed antibiotic prescribing for respiratory tract infections: individual patient data meta-analysis.BMJ. 2021 Apr 28;373:n808. doi: 10.1136/bmj.n808. BMJ. 2021. PMID: 33910882 Free PMC article.
-
Systematic review of determinants influencing antibiotic prescribing for uncomplicated acute respiratory tract infections in adult patients at the emergency department.Infect Control Hosp Epidemiol. 2022 Mar;43(3):366-375. doi: 10.1017/ice.2020.1245. Epub 2020 Oct 29. Infect Control Hosp Epidemiol. 2022. PMID: 33118891
Cited by
-
Novel care pathway to optimise antimicrobial prescribing for uncomplicated community-acquired pneumonia: study protocol for a prospective before-after cohort study in the emergency department of a tertiary care Canadian children's hospital.BMJ Open. 2022 Nov 17;12(11):e062360. doi: 10.1136/bmjopen-2022-062360. BMJ Open. 2022. PMID: 36396301 Free PMC article.
-
Procalcitonin guidance to reduce antibiotic treatment of lower respiratory tract infection in children and adolescents (ProPAED): a randomized controlled trial.PLoS One. 2013 Aug 6;8(8):e68419. doi: 10.1371/journal.pone.0068419. Print 2013. PLoS One. 2013. PMID: 23936304 Free PMC article. Clinical Trial.
-
GPs' views in five European countries of interventions to promote prudent antibiotic use.Br J Gen Pract. 2011 May;61(586):e252-61. doi: 10.3399/bjgp11X572445. Br J Gen Pract. 2011. PMID: 21619749 Free PMC article.
-
Design and rationale of the Procalcitonin Antibiotic Consensus Trial (ProACT), a multicenter randomized trial of procalcitonin antibiotic guidance in lower respiratory tract infection.BMC Emerg Med. 2017 Aug 29;17(1):25. doi: 10.1186/s12873-017-0138-1. BMC Emerg Med. 2017. PMID: 28851296 Free PMC article. Clinical Trial.
-
Evaluation of symptom checkers for self diagnosis and triage: audit study.BMJ. 2015 Jul 8;351:h3480. doi: 10.1136/bmj.h3480. BMJ. 2015. PMID: 26157077 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical