Primary care

Reducing antibiotic use for acute bronchitis in primary care: blinded, randomised controlled trial of patient information leafletCommentary: More self reliance in patients and fewer antibiotics: still room for improvement

BMJ 2002; 324 doi: 10.1136/bmj.324.7329.91 (Published 12 January 2002)
Cite this as: BMJ 2002;324:91.1
  1. John Macfarlane, consultant physiciana,
  2. William Holmes, principal in general practiceb,
  3. Philip Gard, principal in general practicec,
  4. David Thornhill, principal in general practiced,
  5. Rosamund Macfarlane, research administrator (john.macfarlane{at}tinyworld.co.uk)e,
  6. Richard Hubbard, senior lecturer in clinical epidemiologyf
  1. a Respiratory Medicine, Nottingham City Hospital NG5 1PB,
  2. b Sherrington Park Medical Practice, Nottingham NG5 2EJ,
  3. c Arnold Health Centre, Arnold, Nottingham NG5 7BP,
  4. d Stenhouse Medical Centre, Arnold, Nottingham NG5 7BP,
  5. e Respiratory Infection Research Group, Nottingham City Hospital,
  6. f University of Nottingham, Clinical Sciences Building, Nottingham City Hospital
  7. Department of General Practice, University Medical Centre St Radboud, Nijmegen, Netherlands
  1. Correspondence to: J Macfarlane
  • Accepted 20 September 2001

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.

What is already known on this topic

What is already known on this topic Most adults with acute bronchitis who consult their general practitioner will receive antibiotics

For most patients antibiotics do not modify the natural course of the symptoms

The widespread belief among patients that infection is the problem and antibiotics the solution has considerable influence on prescribing by general practitioners, even when they judge that antibiotics are not definitely indicated

What this study adds

What this study adds General practitioners judged that about four in five adults with acute bronchitis did not definitely need antibiotics on the day they consulted

Antibiotic use was reduced by a quarter in such patients, who received verbal and written information and reassurance in addition to a prescription for antibiotics

Sharing with the patient the uncertainty about the decision to prescribe seems safe and effective

Footnotes

  • Funding British Lung Foundation.

  • Competing interests JM has received consultancy fees from Pfizer, Abbott, Hoechst Marion Roussel, Trinity, Glaxo Wellcome; research funding from Hoechst Marion Roussel, Rhone Poulenc Rorer, and Bayer; lecture fees from AstraZeneca, Hoechst Marion Roussel, and Pfizer; and support for attending conferences from Astra, Pfizer, Allen and Hanbury, and 3M. WH has received consultancy fees from Glaxo Wellcome, Schering Plough, Boehringer Ingleheim, Hoechst Marion Roussel, Astra, 3M, Zeneca, and Rhone Poulenc Rorer; research funding from 3M and Rhone Poulenc Rorer; and support for attending conferences or courses from Glaxo Wellcome, Schering Plough, Zeneca, and 3M. RH received support from Bayer for attending two scientific meetings and to support a research project.

  • Accepted 20 September 2001

Commentary: More self reliance in patients and fewer antibiotics: still room for improvement

  1. Chris van Weel, professor (c.vanweel{at}hsv.kun.nl)
  1. a Respiratory Medicine, Nottingham City Hospital NG5 1PB,
  2. b Sherrington Park Medical Practice, Nottingham NG5 2EJ,
  3. c Arnold Health Centre, Arnold, Nottingham NG5 7BP,
  4. d Stenhouse Medical Centre, Arnold, Nottingham NG5 7BP,
  5. e Respiratory Infection Research Group, Nottingham City Hospital,
  6. f University of Nottingham, Clinical Sciences Building, Nottingham City Hospital
  7. Department of General Practice, University Medical Centre St Radboud, Nijmegen, Netherlands

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