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.
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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September 2017
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, 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), .
(doi:10.3399/bjgp17X692321).
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.
Text
Symptom response to antibiotic prescribing strategies in acute sore throat in adults_final author copy
- Accepted Manuscript
More information
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
ISSN: 0960-1643
PURE UUID: 302107e6-a893-4583-9ab5-fa31ddb83dd1
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Date deposited: 03 Aug 2017 16:30
Last modified: 12 Jul 2024 04:08
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Contributors
Author:
F.D. Richard Hobbs
Author:
Christopher Butler
Author:
Alastair D. Hay
Author:
John Campbell
Author:
Brendan C. Delaney
Author:
Paula Barrett
Author:
Kerenza Hood
Author:
David Mant
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