The University of Southampton
University of Southampton Institutional Repository

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
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
0960-1643
e682-e693
Redmond, Niamh M.
dbb0bc92-e3df-47e4-ad16-f392d8f8a8aa
Turnbull, Sophie
135b4809-1046-4b61-803d-b8baeecefc6c
Stuart, Beth
a51c80d3-5855-4672-b24f-8c65fd2e1444
Thornton, Hannah V.
a5efe395-9189-4dbc-b643-de2a045a0fff
Christensen, Hannah
40b98873-db4c-492e-86c8-cad5f6b4630b
Blair, Peter S.
3d5e258e-a342-4f3f-98a3-195267ee7456
Delaney, Brendan C.
2776a608-8a24-46f3-8603-b9b4e831f02e
Thompson, Matthew
6c021dd1-e725-46a2-8b8f-f41bcfc0adfa
Peters, Tim J.
b3ab1e07-326f-41c2-9813-f00f3b75bcf0
Hay, Alastair D.
bfae9e44-ae9b-473c-923f-1dea50747023
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Redmond, Niamh M.
dbb0bc92-e3df-47e4-ad16-f392d8f8a8aa
Turnbull, Sophie
135b4809-1046-4b61-803d-b8baeecefc6c
Stuart, Beth
a51c80d3-5855-4672-b24f-8c65fd2e1444
Thornton, Hannah V.
a5efe395-9189-4dbc-b643-de2a045a0fff
Christensen, Hannah
40b98873-db4c-492e-86c8-cad5f6b4630b
Blair, Peter S.
3d5e258e-a342-4f3f-98a3-195267ee7456
Delaney, Brendan C.
2776a608-8a24-46f3-8603-b9b4e831f02e
Thompson, Matthew
6c021dd1-e725-46a2-8b8f-f41bcfc0adfa
Peters, Tim J.
b3ab1e07-326f-41c2-9813-f00f3b75bcf0
Hay, Alastair D.
bfae9e44-ae9b-473c-923f-1dea50747023
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777

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), e682-e693. (doi:10.3399/bjgp18X698873).

Record type: Article

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.

Text
e682.full - Version of Record
Download (208kB)

More information

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

Identifiers

Local EPrints ID: 425375
URI: http://eprints.soton.ac.uk/id/eprint/425375
ISSN: 0960-1643
PURE UUID: 998a76d4-77b5-41f5-b137-487d8b92db07

Catalogue record

Date deposited: 16 Oct 2018 16:30
Last modified: 06 Oct 2020 22:27

Export record

Altmetrics

Contributors

Author: Niamh M. Redmond
Author: Sophie Turnbull
Author: Beth Stuart
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
Author: Paul Little

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×