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Influence of the duration of penicillin prescriptions on outcomes for acute sore throat in adults: results from the DESCARTE prospective cohort study

Influence of the duration of penicillin prescriptions on outcomes for acute sore throat in adults: results from the DESCARTE prospective cohort study
Influence of the duration of penicillin prescriptions on outcomes for acute sore throat in adults: results from the DESCARTE prospective cohort study
Background. Guidelines recommend 10 day treatment courses for acute sore throat but shorter courses may be used in practice.

Aim. To determine whether antibiotic duration predicts adverse outcome of acute sore throat in adults in routine care.

Design and setting A secondary analysis of a prospective cohort study of 14610 adults presenting with acute sore throat in primary care.

Methods. A brief clinical proforma was used to collect symptom severity and examination findings at presentation. Outcomes were collected by notes review and in a sample a symptom diary.

Primary outcome: Re-consultation with new/non-resolving symptoms within 1 month. Secondary outcome ‘global’ poorer symptom control (longer than the median duration or higher than median severity).

Results. Antibiotics were prescribed for 60% (8572/14610) of participants. The most commonly prescribed antibiotic was phenoxymethylpenicillin (76%, 5656/7474) and prescription durations were largely for 5 (20%), 7 (57%), or 10 (22%) days.. Compared with 5 day courses those receiving longer courses were less likely to re-consult with new or non- resolving symptoms (5 days 15.3%, 7 days 13.9%, 10 days 12.2%, 7 day course adjusted risk ratio 0·92 (0·76, 1·11) and 10 days 0·86 (0·59, 1·23)) but these differences did not reach statistical significance.

Conclusions. In adults prescribed antibiotics for sore throat, we cannot rule out a small advantage in terms of reduced re-consultation for a 10 day course of penicillin but the effect is likely to be small.
0960-1643
e623-e633
Moore, Michael
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Stuart, Beth
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Hobbs, F.D. Richard
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Butler, Christopher C. Butler
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Hay, Alastair D.
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Campbell, John
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Delaney, Brendan C.
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Broomfield, Susan
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Barratt, Paula
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Hood, Kerenza
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Everitt, Hazel
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Mullee, Mark
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Williamson, Ian
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Mant, David
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Little, Paul
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Moore, Michael
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Stuart, Beth
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Hobbs, F.D. Richard
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Butler, Christopher C. Butler
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Hay, Alastair D.
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Campbell, John
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Delaney, Brendan C.
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Broomfield, Susan
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Barratt, Paula
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Hood, Kerenza
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Everitt, Hazel
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Mullee, Mark
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Williamson, Ian
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Mant, David
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Little, Paul
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Moore, Michael, Stuart, Beth, Hobbs, F.D. Richard, Butler, Christopher C. Butler, Hay, Alastair D., Campbell, John, Delaney, Brendan C., Broomfield, Susan, Barratt, Paula, Hood, Kerenza, Everitt, Hazel, Mullee, Mark, Williamson, Ian, Mant, David and Little, Paul (2017) Influence of the duration of penicillin prescriptions on outcomes for acute sore throat in adults: results from the DESCARTE prospective cohort study. British Journal of General Practice, 67 (662), e623-e633. (doi:10.3399/bjgp17X692333).

Record type: Article

Abstract

Background. Guidelines recommend 10 day treatment courses for acute sore throat but shorter courses may be used in practice.

Aim. To determine whether antibiotic duration predicts adverse outcome of acute sore throat in adults in routine care.

Design and setting A secondary analysis of a prospective cohort study of 14610 adults presenting with acute sore throat in primary care.

Methods. A brief clinical proforma was used to collect symptom severity and examination findings at presentation. Outcomes were collected by notes review and in a sample a symptom diary.

Primary outcome: Re-consultation with new/non-resolving symptoms within 1 month. Secondary outcome ‘global’ poorer symptom control (longer than the median duration or higher than median severity).

Results. Antibiotics were prescribed for 60% (8572/14610) of participants. The most commonly prescribed antibiotic was phenoxymethylpenicillin (76%, 5656/7474) and prescription durations were largely for 5 (20%), 7 (57%), or 10 (22%) days.. Compared with 5 day courses those receiving longer courses were less likely to re-consult with new or non- resolving symptoms (5 days 15.3%, 7 days 13.9%, 10 days 12.2%, 7 day course adjusted risk ratio 0·92 (0·76, 1·11) and 10 days 0·86 (0·59, 1·23)) but these differences did not reach statistical significance.

Conclusions. In adults prescribed antibiotics for sore throat, we cannot rule out a small advantage in terms of reduced re-consultation for a 10 day course of penicillin but the effect is likely to be small.

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DESCARTE_penduration_BJGP final_author copy - Accepted Manuscript
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Accepted/In Press date: 15 May 2017
e-pub ahead of print date: 14 August 2017
Published date: 14 August 2017

Identifiers

Local EPrints ID: 412861
URI: http://eprints.soton.ac.uk/id/eprint/412861
ISSN: 0960-1643
PURE UUID: 5da57864-fdf2-4fdd-9f3e-d12c67eceb43
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Beth Stuart: ORCID iD orcid.org/0000-0001-5432-7437
ORCID for Hazel Everitt: ORCID iD orcid.org/0000-0001-7362-8403

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Date deposited: 03 Aug 2017 16:30
Last modified: 18 Feb 2021 17:07

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Contributors

Author: Michael Moore ORCID iD
Author: Beth Stuart ORCID iD
Author: F.D. Richard Hobbs
Author: Christopher C. Butler Butler
Author: Alastair D. Hay
Author: John Campbell
Author: Brendan C. Delaney
Author: Paula Barratt
Author: Kerenza Hood
Author: Hazel Everitt ORCID iD
Author: Mark Mullee
Author: Ian Williamson
Author: David Mant
Author: Paul Little

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