Antibiotic prescription strategies and adverse outcome for uncomplicated lower respiratory tract infections: prospective cough complication cohort (3C) study
Objective To assess the impact on adverse outcomes of different antibiotic prescribing strategies for lower respiratory tract infections in people aged 16 years or more.Design Prospective cohort study.Setting UK general practice.Participants 28 883 patients with lower respiratory tract infection; sy...
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| Veröffentlicht in: | BMJ (Online) 2017-05, Vol.357, p.j2148 |
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| description | Objective To assess the impact on adverse outcomes of different antibiotic prescribing strategies for lower respiratory tract infections in people aged 16 years or more.Design Prospective cohort study.Setting UK general practice.Participants 28 883 patients with lower respiratory tract infection; symptoms, signs, and antibiotic prescribing strategies were recorded at the index consultation.Main outcome measures The main outcomes were reconsultation with symptoms of lower respiratory tract infection in the 30 days after the index consultation, hospital admission, or death. Multivariable analysis controlled for an extensive list of variables related to the propensity to prescribe antibiotics and for clustering by doctor.Results Of the 28 883 participants, 104 (0.4%) were referred to hospital for radiographic investigation or admission, or both on the day of the index consultation, or were admitted with cancer. Of the remaining 28 779, subsequent hospital admission or death occurred in 26/7332 (0.3%) after no antibiotic prescription, 156/17 628 (0.9%) after prescription for immediate antibiotics, and 14/3819 (0.4%) after a prescription for delayed antibiotics. Multivariable analysis documented no reduction in hospital admission and death after immediate antibiotics (multivariable risk ratio 1.06, 95% confidence interval 0.63 to 1.81, P=0.84) and a non-significant reduction with delayed antibiotics (0.81, 0.41 to 1.64, P=0.61). Reconsultation for new, worsening, or non-resolving symptoms was common (1443/7332 (19.7%), 4455/17 628 (25.3%), and 538/3819 (14.1%), respectively) and was significantly reduced by delayed antibiotics (multivariable risk ratio 0.64, 0.57 to 0.72, P |
| doi_str_mv | 10.1136/bmj.j2148 |
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| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5439222</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4322474547</sourcerecordid><originalsourceid>FETCH-LOGICAL-b432t-a6ac642d43c64e9cd559c7032c5b938c1632a0a66f0a866841f73824efbe2f53</originalsourceid><addsrcrecordid>eNp1kc1uEzEUhS1ERaPSRV8AWYIFXUzr__GwQKqiFpAqddO95fHcSRwl48H2BOVheFc8pESwYHVt-dzvHPkgdEXJDaVc3ba7zc2GUaFfoQWtpaqo5vw1WpBGNpWmXJ-jy5Q2hBDGa90o-QadMy05Z0ou0M-7IfvWh-wdHiMkF_2YfRhwytFmWHlI2A4dtt0eYgIcpuzCDnAfIp6Gchy33hVhh7fhB0RcEKMvmyEecCG4jP3Qg5uR6VNxCGmcb3vALkyrNT4RZk8X1iFm_JEvr4v_1B3eorPebhNcvswL9Pxw_7z8Wj0-ffm2vHusWsFZrqyyTgnWCV4GNK6TsnE14czJtuHaUcWZJVapnlitlBa0r7lmAvoWWC_5Bfp8xI5Tu4POwVCib80Y_c7GgwnWm39fBr82q7A3UvCGMVYA718AMXyfIGWzCVMcSmRDG0KpEHVNi-r6qHLlG1KE_uRAiZm7NKVL87vLon33d6ST8k9zRfDhKJh3_s_5BR7Rq1I</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1901144771</pqid></control><display><type>article</type><title>Antibiotic prescription strategies and adverse outcome for uncomplicated lower respiratory tract infections: prospective cough complication cohort (3C) study</title><source>MEDLINE</source><source>Jstor Complete Legacy</source><creator>Little, Paul ; Stuart, Beth ; Smith, Sue ; Thompson, Matthew J ; Knox, Kyle ; van den Bruel, Ann ; Lown, Mark ; Moore, Michael ; Mant, David</creator><creatorcontrib>Little, Paul ; Stuart, Beth ; Smith, Sue ; Thompson, Matthew J ; Knox, Kyle ; van den Bruel, Ann ; Lown, Mark ; Moore, Michael ; Mant, David</creatorcontrib><description>Objective To assess the impact on adverse outcomes of different antibiotic prescribing strategies for lower respiratory tract infections in people aged 16 years or more.Design Prospective cohort study.Setting UK general practice.Participants 28 883 patients with lower respiratory tract infection; symptoms, signs, and antibiotic prescribing strategies were recorded at the index consultation.Main outcome measures The main outcomes were reconsultation with symptoms of lower respiratory tract infection in the 30 days after the index consultation, hospital admission, or death. Multivariable analysis controlled for an extensive list of variables related to the propensity to prescribe antibiotics and for clustering by doctor.Results Of the 28 883 participants, 104 (0.4%) were referred to hospital for radiographic investigation or admission, or both on the day of the index consultation, or were admitted with cancer. Of the remaining 28 779, subsequent hospital admission or death occurred in 26/7332 (0.3%) after no antibiotic prescription, 156/17 628 (0.9%) after prescription for immediate antibiotics, and 14/3819 (0.4%) after a prescription for delayed antibiotics. Multivariable analysis documented no reduction in hospital admission and death after immediate antibiotics (multivariable risk ratio 1.06, 95% confidence interval 0.63 to 1.81, P=0.84) and a non-significant reduction with delayed antibiotics (0.81, 0.41 to 1.64, P=0.61). Reconsultation for new, worsening, or non-resolving symptoms was common (1443/7332 (19.7%), 4455/17 628 (25.3%), and 538/3819 (14.1%), respectively) and was significantly reduced by delayed antibiotics (multivariable risk ratio 0.64, 0.57 to 0.72, P<0.001) but not by immediate antibiotics (0.98, 0.90 to 1.07, P=0.66).Conclusion Prescribing immediate antibiotics may not reduce subsequent hospital admission or death for young people and adults with uncomplicated lower respiratory tract infection, and such events are uncommon. If clinicians are considering antibiotics, a delayed prescription may be preferable since it is associated with a reduced number of reconsultations for worsening illness.</description><identifier>ISSN: 0959-8138</identifier><identifier>EISSN: 1756-1833</identifier><identifier>DOI: 10.1136/bmj.j2148</identifier><identifier>PMID: 28533265</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Anti-Bacterial Agents - adverse effects ; Anti-Bacterial Agents - therapeutic use ; Antibiotics ; Consent ; Cough - diagnosis ; Cough - drug therapy ; Drug Prescriptions ; Effectiveness ; Female ; General Practice ; Hospitals ; Humans ; Illnesses ; Immunization ; Infections ; Male ; Medical records ; Middle Aged ; Missing data ; Oxygen saturation ; Patients ; Physicians ; Practice Patterns, Physicians' - statistics & numerical data ; Primary care ; Prospective Studies ; Respiratory Tract Infections - diagnosis ; Respiratory Tract Infections - drug therapy ; Treatment Outcome ; United Kingdom</subject><ispartof>BMJ (Online), 2017-05, Vol.357, p.j2148</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><rights>Copyright: 2017 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to 2017 BMJ</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b432t-a6ac642d43c64e9cd559c7032c5b938c1632a0a66f0a866841f73824efbe2f53</citedby><cites>FETCH-LOGICAL-b432t-a6ac642d43c64e9cd559c7032c5b938c1632a0a66f0a866841f73824efbe2f53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28533265$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Little, Paul</creatorcontrib><creatorcontrib>Stuart, Beth</creatorcontrib><creatorcontrib>Smith, Sue</creatorcontrib><creatorcontrib>Thompson, Matthew J</creatorcontrib><creatorcontrib>Knox, Kyle</creatorcontrib><creatorcontrib>van den Bruel, Ann</creatorcontrib><creatorcontrib>Lown, Mark</creatorcontrib><creatorcontrib>Moore, Michael</creatorcontrib><creatorcontrib>Mant, David</creatorcontrib><title>Antibiotic prescription strategies and adverse outcome for uncomplicated lower respiratory tract infections: prospective cough complication cohort (3C) study</title><title>BMJ (Online)</title><addtitle>BMJ</addtitle><description>Objective To assess the impact on adverse outcomes of different antibiotic prescribing strategies for lower respiratory tract infections in people aged 16 years or more.Design Prospective cohort study.Setting UK general practice.Participants 28 883 patients with lower respiratory tract infection; symptoms, signs, and antibiotic prescribing strategies were recorded at the index consultation.Main outcome measures The main outcomes were reconsultation with symptoms of lower respiratory tract infection in the 30 days after the index consultation, hospital admission, or death. Multivariable analysis controlled for an extensive list of variables related to the propensity to prescribe antibiotics and for clustering by doctor.Results Of the 28 883 participants, 104 (0.4%) were referred to hospital for radiographic investigation or admission, or both on the day of the index consultation, or were admitted with cancer. Of the remaining 28 779, subsequent hospital admission or death occurred in 26/7332 (0.3%) after no antibiotic prescription, 156/17 628 (0.9%) after prescription for immediate antibiotics, and 14/3819 (0.4%) after a prescription for delayed antibiotics. Multivariable analysis documented no reduction in hospital admission and death after immediate antibiotics (multivariable risk ratio 1.06, 95% confidence interval 0.63 to 1.81, P=0.84) and a non-significant reduction with delayed antibiotics (0.81, 0.41 to 1.64, P=0.61). Reconsultation for new, worsening, or non-resolving symptoms was common (1443/7332 (19.7%), 4455/17 628 (25.3%), and 538/3819 (14.1%), respectively) and was significantly reduced by delayed antibiotics (multivariable risk ratio 0.64, 0.57 to 0.72, P<0.001) but not by immediate antibiotics (0.98, 0.90 to 1.07, P=0.66).Conclusion Prescribing immediate antibiotics may not reduce subsequent hospital admission or death for young people and adults with uncomplicated lower respiratory tract infection, and such events are uncommon. If clinicians are considering antibiotics, a delayed prescription may be preferable since it is associated with a reduced number of reconsultations for worsening illness.</description><subject>Anti-Bacterial Agents - adverse effects</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Consent</subject><subject>Cough - diagnosis</subject><subject>Cough - drug therapy</subject><subject>Drug Prescriptions</subject><subject>Effectiveness</subject><subject>Female</subject><subject>General Practice</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Illnesses</subject><subject>Immunization</subject><subject>Infections</subject><subject>Male</subject><subject>Medical records</subject><subject>Middle Aged</subject><subject>Missing data</subject><subject>Oxygen saturation</subject><subject>Patients</subject><subject>Physicians</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>Primary care</subject><subject>Prospective Studies</subject><subject>Respiratory Tract Infections - diagnosis</subject><subject>Respiratory Tract Infections - drug therapy</subject><subject>Treatment Outcome</subject><subject>United 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Paul</creator><creator>Stuart, Beth</creator><creator>Smith, Sue</creator><creator>Thompson, Matthew J</creator><creator>Knox, Kyle</creator><creator>van den Bruel, Ann</creator><creator>Lown, Mark</creator><creator>Moore, Michael</creator><creator>Mant, David</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group Ltd</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>5PM</scope></search><sort><creationdate>20170522</creationdate><title>Antibiotic prescription strategies and adverse outcome for uncomplicated lower respiratory tract infections: prospective cough complication cohort (3C) study</title><author>Little, Paul ; Stuart, Beth ; Smith, Sue ; Thompson, Matthew J ; Knox, Kyle ; van den Bruel, Ann ; Lown, Mark ; Moore, Michael ; Mant, David</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b432t-a6ac642d43c64e9cd559c7032c5b938c1632a0a66f0a866841f73824efbe2f53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Anti-Bacterial Agents - adverse effects</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotics</topic><topic>Consent</topic><topic>Cough - diagnosis</topic><topic>Cough - drug therapy</topic><topic>Drug Prescriptions</topic><topic>Effectiveness</topic><topic>Female</topic><topic>General Practice</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Illnesses</topic><topic>Immunization</topic><topic>Infections</topic><topic>Male</topic><topic>Medical records</topic><topic>Middle Aged</topic><topic>Missing data</topic><topic>Oxygen saturation</topic><topic>Patients</topic><topic>Physicians</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>Primary care</topic><topic>Prospective Studies</topic><topic>Respiratory Tract Infections - diagnosis</topic><topic>Respiratory Tract Infections - drug therapy</topic><topic>Treatment Outcome</topic><topic>United Kingdom</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Little, Paul</creatorcontrib><creatorcontrib>Stuart, Beth</creatorcontrib><creatorcontrib>Smith, Sue</creatorcontrib><creatorcontrib>Thompson, Matthew J</creatorcontrib><creatorcontrib>Knox, Kyle</creatorcontrib><creatorcontrib>van den Bruel, Ann</creatorcontrib><creatorcontrib>Lown, Mark</creatorcontrib><creatorcontrib>Moore, Michael</creatorcontrib><creatorcontrib>Mant, David</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ (Online)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Little, Paul</au><au>Stuart, Beth</au><au>Smith, Sue</au><au>Thompson, Matthew J</au><au>Knox, Kyle</au><au>van den Bruel, Ann</au><au>Lown, Mark</au><au>Moore, Michael</au><au>Mant, David</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antibiotic prescription strategies and adverse outcome for uncomplicated lower respiratory tract infections: prospective cough complication cohort (3C) study</atitle><jtitle>BMJ (Online)</jtitle><addtitle>BMJ</addtitle><date>2017-05-22</date><risdate>2017</risdate><volume>357</volume><spage>j2148</spage><pages>j2148-</pages><issn>0959-8138</issn><eissn>1756-1833</eissn><abstract>Objective To assess the impact on adverse outcomes of different antibiotic prescribing strategies for lower respiratory tract infections in people aged 16 years or more.Design Prospective cohort study.Setting UK general practice.Participants 28 883 patients with lower respiratory tract infection; symptoms, signs, and antibiotic prescribing strategies were recorded at the index consultation.Main outcome measures The main outcomes were reconsultation with symptoms of lower respiratory tract infection in the 30 days after the index consultation, hospital admission, or death. Multivariable analysis controlled for an extensive list of variables related to the propensity to prescribe antibiotics and for clustering by doctor.Results Of the 28 883 participants, 104 (0.4%) were referred to hospital for radiographic investigation or admission, or both on the day of the index consultation, or were admitted with cancer. Of the remaining 28 779, subsequent hospital admission or death occurred in 26/7332 (0.3%) after no antibiotic prescription, 156/17 628 (0.9%) after prescription for immediate antibiotics, and 14/3819 (0.4%) after a prescription for delayed antibiotics. Multivariable analysis documented no reduction in hospital admission and death after immediate antibiotics (multivariable risk ratio 1.06, 95% confidence interval 0.63 to 1.81, P=0.84) and a non-significant reduction with delayed antibiotics (0.81, 0.41 to 1.64, P=0.61). Reconsultation for new, worsening, or non-resolving symptoms was common (1443/7332 (19.7%), 4455/17 628 (25.3%), and 538/3819 (14.1%), respectively) and was significantly reduced by delayed antibiotics (multivariable risk ratio 0.64, 0.57 to 0.72, P<0.001) but not by immediate antibiotics (0.98, 0.90 to 1.07, P=0.66).Conclusion Prescribing immediate antibiotics may not reduce subsequent hospital admission or death for young people and adults with uncomplicated lower respiratory tract infection, and such events are uncommon. If clinicians are considering antibiotics, a delayed prescription may be preferable since it is associated with a reduced number of reconsultations for worsening illness.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>28533265</pmid><doi>10.1136/bmj.j2148</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Anti-Bacterial Agents - adverse effects Anti-Bacterial Agents - therapeutic use Antibiotics Consent Cough - diagnosis Cough - drug therapy Drug Prescriptions Effectiveness Female General Practice Hospitals Humans Illnesses Immunization Infections Male Medical records Middle Aged Missing data Oxygen saturation Patients Physicians Practice Patterns, Physicians' - statistics & numerical data Primary care Prospective Studies Respiratory Tract Infections - diagnosis Respiratory Tract Infections - drug therapy Treatment Outcome United Kingdom |
| title | Antibiotic prescription strategies and adverse outcome for uncomplicated lower respiratory tract infections: prospective cough complication cohort (3C) study |
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