BMJ 2002;324:91 ( 12 January )

Primary care

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

John Macfarlane, consultant physician, ^a William Holmes, principal in general practice, ^b Philip Gard, principal in general practice, ^c David Thornhill, principal in general practice, ^d Rosamund Macfarlane, research administrator, ^e Richard Hubbard, senior lecturer in clinical epidemiology. ^f

^a Respiratory Medicine, Nottingham City Hospital NG5 1PB, ^b Sherrington Park Medical Practice, Nottingham NG5 2EJ, ^c Arnold Health Centre, Arnold, Nottingham NG5 7BP, ^d Stenhouse Medical Centre, Arnold, Nottingham NG5 7BP, ^e Respiratory Infection Research Group, Nottingham City Hospital, ^f University of Nottingham, Clinical Sciences Building, Nottingham City Hospital

Correspondence to: J Macfarlane john.macfarlane{at}tinyworld.co.uk

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 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 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

---

© BMJ 2002
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Effect of using an interactive booklet about childhood respiratory tract infections in primary care consultations on reconsulting and antibiotic prescribing: a cluster randomised controlled trial

Nick A Francis, Christopher C Butler, Kerenza Hood, Sharon Simpson, Fiona Wood, and Jacqueline Nuttall
BMJ 2009 339: b2885. [Abstract] [Full Text] [PDF]

Antibiotics for acute cough in primary care

Alastair D Hay and Katy V Jüttner
BMJ 2009 338: b834. [Extract] [Full Text]

Giving patients more information reduces antibiotic use
BMJ 2002 324: 0. [Full Text]

This article has been cited by other articles:

• Gulliford, M., Latinovic, R., Charlton, J., Little, P., van Staa, T., Ashworth, M. (2009). Selective decrease in consultations and antibiotic prescribing for acute respiratory tract infections in UK primary care up to 2006. J Public Health (Oxf) 31: 512-520 [Abstract] [Full text]  
• Visscher, K. L., Hutnik, C. M. L., Thomas, M. (2009). Evidence-based treatment of acute infective conjunctivitis: Breaking the cycle of antibiotic prescribing. cfp 55: 1071-1075 [Abstract] [Full text]  
• Francis, N. A, Butler, C. C, Hood, K., Simpson, S., Wood, F., Nuttall, J. (2009). Effect of using an interactive booklet about childhood respiratory tract infections in primary care consultations on reconsulting and antibiotic prescribing: a cluster randomised controlled trial. BMJ 339: b2885-b2885 [Abstract] [Full text]  
• Hay, A. D, Juttner, K. V (2009). Antibiotics for acute cough in primary care. BMJ 338: b834-b834 [Full text]  
• Altiner, A., Brockmann, S., Sielk, M., Wilm, S., Wegscheider, K., Abholz, H.-H. (2007). Reducing antibiotic prescriptions for acute cough by motivating GPs to change their attitudes to communication and empowering patients: a cluster-randomized intervention study. J Antimicrob Chemother 60: 638-644 [Abstract] [Full text]  
• Wutzke, S. E., Artist, M. A., Kehoe, L. A., Fletcher, M., Mackson, J. M., Weekes, L. M. (2007). Evaluation of a national programme to reduce inappropriate use of antibiotics for upper respiratory tract infections: effects on consumer awareness, beliefs, attitudes and behaviour in Australia. HEALTH PROMOT INT 22: 53-64 [Abstract] [Full text]  
• Harris, M, Smith, B J, Veale, A, Esterman, A, Frith, P A, Selim, P (2006). Providing patients with reviews of evidence about COPD treatments: a controlled trial of outcomes. Chronic Respiratory Disease 3: 133-140 [Abstract]  
• Welschen, I., Kuyvenhoven, M., Hoes, A., Verheij, T. (2004). Antibiotics for acute respiratory tract symptoms: patients' expectations, GPs' management and patient satisfaction. Fam Pract 21: 234-237 [Abstract] [Full text]  
• Hay, A. D, Wilson, A., Fahey, T., Peters, T. J (2003). The duration of acute cough in pre-school children presenting to primary care: a prospective cohort study. Fam Pract 20: 696-705 [Abstract] [Full text]  
• Pshetizky, Y., Naimer, S., Shvartzman, P. (2003). Acute otitis media--a brief explanation to parents and antibiotic use. Fam Pract 20: 417-419 [Abstract] [Full text]  
• Hickman, D. E, Stebbins, M. R, Hanak, J. R, Guglielmo, B J. (2003). Pharmacy-Based Intervention to Reduce Antibiotic Use for Acute Bronchitis. The Annals of Pharmacotherapy 37: 187-191 [Abstract] [Full text]  
• Becker, L. A (2002). Verbal advice plus an information leaflet reduced antibiotic use in acute bronchitis. Evid. Based Med. 7: 119-119 [Full text]  
• Wright, S. (2002). Verbal advice plus an information leaflet reduced antibiotic use in patients presenting with acute bronchitis. Evid. Based Nurs. 5: 79-79 [Full text]  
• (2002). An Educational Brochure May Decrease Inappropriate Antibiotic Use for Acute Bronchitis. JWatch Emergency Med. 2002: 11-11 [Full text]  
• (2002). Simple Technique Reduces Unnecessary Antibiotic Use in Acute Bronchitis. JWatch General 2002: 4-4 [Full text]  

Rapid Responses:

Read all Rapid Responses

Unavoidable the Bed-side "etiological" Diagnosis of infectious disorder.

Sergio Stagnaro
bmj.com, 12 Jan 2002 [Full text]

Doctors' views effect patients' opinions

Dr Andrew M Thornett, MRCGP
bmj.com, 12 Jan 2002 [Full text]

A patient's experience

Alan M Smith
bmj.com, 13 Jan 2002 [Full text]

Two days wait not enough.

Richard Watson
bmj.com, 14 Jan 2002 [Full text]

Reducing antibiotic use for acute bronchitis in primary care

Rakesh Raja
bmj.com, 15 Jan 2002 [Full text]

The antibiotic Dilemma

James W P Preston
bmj.com, 17 Jan 2002 [Full text]

GPs assessment of antibiotic need may be incorrect

Mike Thomas, et al.
bmj.com, 18 Jan 2002 [Full text]

Use/abuse of antibiotics in acute bronchitis

Niranjan Bhattacharya, MBBS, MD,MS, FACS(USA)
bmj.com, 22 Jan 2002 [Full text]

Clarification of the chest signs

Bruce Arroll
bmj.com, 25 Jan 2002 [Full text]

acute bronchitis: infection or inflammation?

Henk A Thiadens
bmj.com, 7 Feb 2002 [Full text]

Online poll

Find out more on doc2doc >>