Impact of antibiotics for children presenting to general practice with cough on adverse outcomes: secondary analysis from a multicentre prospective cohort study
Impact of antibiotics for children presenting to general practice with cough on adverse outcomes: secondary analysis from a multicentre prospective cohort study
BACKGROUND: Clinicians commonly prescribe antibiotics to prevent major adverse outcomes in children presenting in primary care with cough and respiratory symptoms, despite limited meaningful evidence of impact on these outcomes.
AIM: To estimate the effect of children's antibiotic prescribing on adverse outcomes within 30 days of initial consultation.
DESIGN AND SETTING: Secondary analysis of 8320 children in a multicentre prospective cohort study, aged 3 months to <16 years, presenting in primary care across England with acute cough and other respiratory symptoms.
METHOD: Baseline clinical characteristics and antibiotic prescribing data were collected, and generalised linear models were used to estimate the effect of antibiotic prescribing on adverse outcomes within 30 days (subsequent hospitalisations and reconsultation for deterioration), controlling for clustering and clinicians' propensity to prescribe antibiotics.
RESULTS: Sixty-five (0.8%) children were hospitalised and 350 (4%) reconsulted for deterioration. Clinicians prescribed immediate and delayed antibiotics to 2313 (28%) and 771 (9%), respectively. Compared with no antibiotics, there was no clear evidence that antibiotics reduced hospitalisations (immediate antibiotic risk ratio [RR] 0.83, 95% confidence interval [CI] = 0.47 to 1.45; delayed RR 0.70, 95% CI = 0.26 to 1.90, overall P = 0.44). There was evidence that delayed (rather than immediate) antibiotics reduced reconsultations for deterioration (immediate RR 0.82, 95% CI = 0.65 to 1.07; delayed RR 0.55, 95% CI = 0.34 to 0.88, overall P = 0.024).
CONCLUSION: Most children presenting with acute cough and respiratory symptoms in primary care are not at risk of hospitalisation, and antibiotics may not reduce the risk. If an antibiotic is considered, a delayed antibiotic prescription may be preferable as it is likely to reduce reconsultation for deterioration.
adverse outcomes, antibiotics, children, cohort studies, primary care, respiratory tract infections
e682-e693
Redmond, Niamh M.
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Turnbull, Sophie
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Stuart, Beth
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Thornton, Hannah V.
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Christensen, Hannah
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Blair, Peter S.
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Delaney, Brendan C.
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Thompson, Matthew
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Peters, Tim J.
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Hay, Alastair D.
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Little, Paul
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1 October 2018
Redmond, Niamh M.
dbb0bc92-e3df-47e4-ad16-f392d8f8a8aa
Turnbull, Sophie
135b4809-1046-4b61-803d-b8baeecefc6c
Stuart, Beth
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Thornton, Hannah V.
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Christensen, Hannah
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Blair, Peter S.
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Delaney, Brendan C.
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Thompson, Matthew
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Peters, Tim J.
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Hay, Alastair D.
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Little, Paul
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Redmond, Niamh M., Turnbull, Sophie, Stuart, Beth, Thornton, Hannah V., Christensen, Hannah, Blair, Peter S., Delaney, Brendan C., Thompson, Matthew, Peters, Tim J., Hay, Alastair D. and Little, Paul
(2018)
Impact of antibiotics for children presenting to general practice with cough on adverse outcomes: secondary analysis from a multicentre prospective cohort study.
The British journal of general practice : the journal of the Royal College of General Practitioners, 68 (675), .
(doi:10.3399/bjgp18X698873).
Abstract
BACKGROUND: Clinicians commonly prescribe antibiotics to prevent major adverse outcomes in children presenting in primary care with cough and respiratory symptoms, despite limited meaningful evidence of impact on these outcomes.
AIM: To estimate the effect of children's antibiotic prescribing on adverse outcomes within 30 days of initial consultation.
DESIGN AND SETTING: Secondary analysis of 8320 children in a multicentre prospective cohort study, aged 3 months to <16 years, presenting in primary care across England with acute cough and other respiratory symptoms.
METHOD: Baseline clinical characteristics and antibiotic prescribing data were collected, and generalised linear models were used to estimate the effect of antibiotic prescribing on adverse outcomes within 30 days (subsequent hospitalisations and reconsultation for deterioration), controlling for clustering and clinicians' propensity to prescribe antibiotics.
RESULTS: Sixty-five (0.8%) children were hospitalised and 350 (4%) reconsulted for deterioration. Clinicians prescribed immediate and delayed antibiotics to 2313 (28%) and 771 (9%), respectively. Compared with no antibiotics, there was no clear evidence that antibiotics reduced hospitalisations (immediate antibiotic risk ratio [RR] 0.83, 95% confidence interval [CI] = 0.47 to 1.45; delayed RR 0.70, 95% CI = 0.26 to 1.90, overall P = 0.44). There was evidence that delayed (rather than immediate) antibiotics reduced reconsultations for deterioration (immediate RR 0.82, 95% CI = 0.65 to 1.07; delayed RR 0.55, 95% CI = 0.34 to 0.88, overall P = 0.024).
CONCLUSION: Most children presenting with acute cough and respiratory symptoms in primary care are not at risk of hospitalisation, and antibiotics may not reduce the risk. If an antibiotic is considered, a delayed antibiotic prescription may be preferable as it is likely to reduce reconsultation for deterioration.
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Accepted/In Press date: 2 July 2018
e-pub ahead of print date: 27 September 2018
Published date: 1 October 2018
Keywords:
adverse outcomes, antibiotics, children, cohort studies, primary care, respiratory tract infections
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Local EPrints ID: 425375
URI: http://eprints.soton.ac.uk/id/eprint/425375
ISSN: 0960-1643
PURE UUID: 998a76d4-77b5-41f5-b137-487d8b92db07
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Date deposited: 16 Oct 2018 16:30
Last modified: 12 Jul 2024 01:44
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Contributors
Author:
Niamh M. Redmond
Author:
Sophie Turnbull
Author:
Hannah V. Thornton
Author:
Hannah Christensen
Author:
Peter S. Blair
Author:
Brendan C. Delaney
Author:
Matthew Thompson
Author:
Tim J. Peters
Author:
Alastair D. Hay
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