Research News

Patients with coughs don’t need antibiotics—pass it on

BMJ 2013; 346 doi: (Published 16 January 2013) Cite this as: BMJ 2013;346:f254

When US researchers tested a complex intervention to discourage inappropriate antibiotic prescribing for uncomplicated bronchitis, they were rewarded with a significant drop in primary care prescriptions over one winter season. Printed leaflets, posters, and algorithms seemed to work, as well as similar materials incorporated into computerised decision support. Prescriptions for antibiotics fell from 80% to 67% among patients with bronchitis in the print strategy group and from 74% to 61% in the computerised strategy group. Prescriptions went up slightly in control practices.

Could this be another effective way to change doctors’ behaviour? Not really, says a linked editorial (doi:10.1001/jamainternmed.2013.1984). Healthy people with uncomplicated bronchitis should never be given antibiotics. We have known this for 40 years and should be aiming for prescribing rates below 10%.

Efforts to change have been well made and well evaluated. We know what works, but nothing seems to work well enough. Traditional medical interventions have failed, and it may be time to look further afield to business leaders, behavioural economists, and psychologists for inspiration. We might also be clearer with patients about just what they can expect from antibiotics—a few will recover slightly faster, between 5% and 25% will have an adverse reaction, and at least one in every 1000 will present to an emergency department with a serious drug related event.


Cite this as: BMJ 2013;346:f254