A randomised controlled factorial trial of antibiotic prescribing strategies and an information leaflet about natural history for acute lower respiratory tract infection

Abstract number: 1133_12

Little P., Rumsby K., Kelly J., Watson L., Williamson I., Moore M., Warner G., Fahey T.

Background:  

Acute LRTI is the most common condition managed in primary care. The systematic reviews of antibiotics are small and come to different conclusions, and many physicians still prescribe antibiotics.

Methods:  

807 patients with acute LRTI were randomised to three prescribing strategies – immediate antibiotics, delayed prescription, and no offer of antibiotics. Half of each of these groups received an information leaflet.

Results:  

Cough rated at least ‘a slight problem’ lasted on average 11.7 days (25% lasted 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 ­0.37 to 1.88; immediate +0.11 days, ­1.01 to 1.24) nor other primary outcomes. Antibiotics reduced duration of ‘moderately bad’ symptoms, a secondary outcome, by one day (­1.08; ­2.1 to ­0.09). Compared with the antibiotic group slightly fewer patients were ‘very satisfied’ in the delayed and control groups (respectively 86%, 77%, 72%, p < 0.005), fewer used antibiotics (96%, 20%,16%, p < 0.001) and fewer believed in the effectiveness of antibiotics (75%, 40%, 47%, p < 0.001). There was lower re-attendance for cough within a month with delayed and immediate prescribing (mean attendances: no antibiotics 0.19, delayed 0.12, immediate 0.11, Kruskal Wallis p = 0.03).

Conclusion:  

For most patients with acute uncomplicated LRTI, no offer or a delayed offer of antibiotics was acceptable, associated with little difference in symptom resolution, and considerably reduced antibiotic use and beliefs in antibiotics. Delayed prescribing may have some advantages to not prescribing since fewer patients reconsulted.