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Symptom response to antibiotic prescribing strategies in acute sore throat in adults: results from the DESCARTE prospective cohort study

Symptom response to antibiotic prescribing strategies in acute sore throat in adults: results from the DESCARTE prospective cohort study
Symptom response to antibiotic prescribing strategies in acute sore throat in adults: results from the DESCARTE prospective cohort study
Abstract Background A delayed or just in case prescription has been identified as having potential to reduce antibiotic use in sore throat. Aim To determine the symptomatic outcome of acute sore throat in adults according to antibiotic prescription strategy in routine care. Design and Setting A prospective cohort study comprising adults age over 16 presenting with acute sore throat (<=2 weeks duration) managed with treatment as usual in primary care. Methods. A random sample of 2876 from the full cohort were requested to complete a symptom diary. A brief clinical proforma was used to collect symptom severity and examination findings at presentation. Outcomes details collected by notes review and a detailed symptom diary. The primary outcome was poorer ‘global’ symptom control (defined as longer than the median duration or higher than median symptom severity). Analyses controlled for confounding by indication (propensity to prescribe antibiotics). Results. 1629/2876 (57%) of those requested returned a symptom diary of whom 1512 had information on prescribing strategy. The proportion with poorer global symptom control was greater in those not prescribed antibiotics 393/578 (68%) compared to those prescribed immediate antibiotics 423/723 (60%) or delayed antibiotic prescription 112/193 (58%); adjusted risk ratio (95% confidence interval), immediate 0.87 (0.70-0.96) p=0.006, delayed 0.88 (0.78-1.00). p=0.042. Conclusions. In the routine care of adults with sore throats a delayed antibiotic strategy confers similar symptomatic benefits to immediate antibiotics compared to no antibiotics. If a decision is made to prescribe an antibiotic, a delayed antibiotic strategy is likely to yield similar symptomatic benefit to immediate antibiotics.
0960-1643
e634-e642
Moore, Michael
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Stuart, Beth
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Hobbs, F.D. Richard
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Butler, Christopher
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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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Barrett, Paula
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Hood, Kerenza
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Everitt, Hazel A.
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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
626862fc-892b-4f6d-9cbb-7a8d7172b209
Hobbs, F.D. Richard
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Butler, Christopher
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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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Barrett, Paula
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Hood, Kerenza
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Everitt, Hazel A.
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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, Hay, Alastair D., Campbell, John, Delaney, Brendan C., Broomfield, Susan, Barrett, Paula, Hood, Kerenza, Everitt, Hazel A., Mullee, Mark, Williamson, Ian, Mant, David and Little, Paul (2017) Symptom response to antibiotic prescribing strategies in acute sore throat in adults: results from the DESCARTE prospective cohort study. British Journal of General Practice, 67 (662), e634-e642. (doi:10.3399/bjgp17X692321).

Record type: Article

Abstract

Abstract Background A delayed or just in case prescription has been identified as having potential to reduce antibiotic use in sore throat. Aim To determine the symptomatic outcome of acute sore throat in adults according to antibiotic prescription strategy in routine care. Design and Setting A prospective cohort study comprising adults age over 16 presenting with acute sore throat (<=2 weeks duration) managed with treatment as usual in primary care. Methods. A random sample of 2876 from the full cohort were requested to complete a symptom diary. A brief clinical proforma was used to collect symptom severity and examination findings at presentation. Outcomes details collected by notes review and a detailed symptom diary. The primary outcome was poorer ‘global’ symptom control (defined as longer than the median duration or higher than median symptom severity). Analyses controlled for confounding by indication (propensity to prescribe antibiotics). Results. 1629/2876 (57%) of those requested returned a symptom diary of whom 1512 had information on prescribing strategy. The proportion with poorer global symptom control was greater in those not prescribed antibiotics 393/578 (68%) compared to those prescribed immediate antibiotics 423/723 (60%) or delayed antibiotic prescription 112/193 (58%); adjusted risk ratio (95% confidence interval), immediate 0.87 (0.70-0.96) p=0.006, delayed 0.88 (0.78-1.00). p=0.042. Conclusions. In the routine care of adults with sore throats a delayed antibiotic strategy confers similar symptomatic benefits to immediate antibiotics compared to no antibiotics. If a decision is made to prescribe an antibiotic, a delayed antibiotic strategy is likely to yield similar symptomatic benefit to immediate antibiotics.

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Symptom response to antibiotic prescribing strategies in acute sore throat in adults_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: September 2017

Identifiers

Local EPrints ID: 412862
URI: http://eprints.soton.ac.uk/id/eprint/412862
DOI: doi:10.3399/bjgp17X692321
ISSN: 0960-1643
PURE UUID: 302107e6-a893-4583-9ab5-fa31ddb83dd1
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 A. Everitt: ORCID iD orcid.org/0000-0001-7362-8403

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Date deposited: 03 Aug 2017 16:30
Last modified: 16 Mar 2024 05:36

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Contributors

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

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