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.
RCT Entities:
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.
Authors: J Macfarlane; W Holmes; P Gard; R Macfarlane; D Rose; V Weston; M Leinonen; P Saikku; S Myint Journal: Thorax Date: 2001-02 Impact factor: 9.139
Authors: Martin Gulliford; Radoslav Latinovic; Judith Charlton; Paul Little; Tjeerd van Staa; Mark Ashworth Journal: J Public Health (Oxf) Date: 2009-09-04 Impact factor: 2.341