Quantitative systematic review of randomised controlled trials comparing antibiotic with placebo for acute cough in adults

Fahey, Tom; Stocks, Nigel; Thomas, Toby

doi:10.1136/bmj.316.7135.906

Cited by 136 publications

(66 citation statements)

References 25 publications

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“…Because there is no underlying lung disease in this group, the illness is usually self-limited and runs a benign course. Most placebo-controlled trials have failed to support a role for antibiotic therapy in this group of patients, although meta-analyses of these trials gave conflicting results (294)(295)(296). However, none of these meta-analyses demonstrated a positive impact of antibiotics on duration of illness, limitation of activities or return to work.…”

Section: Risk Stratificationmentioning

confidence: 99%

Canadian Guidelines for the Management of Acute Exacerbations of Chronic Bronchitis

Balter

Forge

Low

et al. 2003

Canadian Respiratory Journal

116

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Acute exacerbations of chronic bronchitis (AECB) account for over 1.5 million physician visits annually in Canada and are a cause of significant morbidity and mortality. This document represents a joint effort between respirologists, microbiologists, infectious disease specialists and family physicians to update the Canadian AECB guidelines published in 1994. Treatment recommendations are graded on the strength of evidence in the published literature where possible. The role for oral corticosteroid therapy in preventing treatment failures, speeding up recovery and delaying the time to next exacerbation is discussed. Risk factors for treatment failure were used to stratify patients into risk groups to help guide antibiotic treatment recommendations. The importance of emerging antimicrobial resistance to current antibiotics is reviewed and strategies to prevent future AECB episodes are suggested.

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Section: Risk Stratificationmentioning

confidence: 99%

Canadian Guidelines for the Management of Acute Exacerbations of Chronic Bronchitis

Balter

Forge

Low

et al. 2003

Canadian Respiratory Journal

116

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show abstract

“…Meta-analyses also show that in most cases antibiotics do not offer any benefits which outweigh the possible side effects. 3,26 As a result, research into a more effective use of antibiotics has to pay special attention to the doctor-and patientrelated factors in the relationship and communication between GPs and patients.…”

Section: Wmentioning

confidence: 99%

Antibiotics for coughing in general practice: a qualitative decision analysis

et al. 2000

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“…4,5 However, recent systematic reviews have come to different conclusions about the likely effectiveness of antibiotics. 6,7 The debate continues unabated about the role of antibiotics because these reviews are relatively small (14 trials of 1500 patients). 1 The study's hypothesis was that prescribing antibiotics for self-limiting illness is likely to reinforce belief in the effectiveness of antibiotics, leading to a cycle of reconsultation and further antibiotic prescribing.…”

Section: Introductionmentioning

confidence: 99%

Effect of antibiotic prescribing strategies and an information leaflet on longer-term reconsultation for acute lower respiratory tract infection

Moore¹,

Little²,

Rumsby³

et al. 2009

Br J Gen Pract

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Limited evidence suggests that delayed prescribing may influence future consultation behaviour. AimTo assess the effects of antibiotic prescribing strategy on reconsultation in the year following presentation with acute lower respiratory tract infection (LRTI). Design of studyBalanced factorial randomised trial. SettingPrimary care. MethodEight hundred and seven subjects, aged ≥3 years, had acute illness presenting with cough as the main symptom, plus at least one symptom or sign from sputum, chest pain, dyspnoea or wheeze. The subjects were randomised to one of three prescribing strategies (antibiotics, delayed antibiotic, no antibiotic) and a leaflet. Prior antibiotic use and reconsultation were assessed by medical record review. ResultsPatients who had been prescribed antibiotic for cough in the previous 2 years were much more likely to reconsult (incidence rate ratio [IRR] = 2.55, 95% confidence interval [CI] = 1.62 to 4.01) and use of a delayed prescription strategy is associated with reduced reconsultation in this group. In those with prior antibiotic exposure, there was a 34% reduction in consultation rate in the no antibiotic group (IRR = 0.66, 0.30 to 1.44, P = 0.295) and a 78% reduction for the delayed antibiotic group (IRR = 0.22, 0.10 to 0.49, P<0.001) when compared with those given immediate antibiotics. This effect was not observed in patients who had not been prescribed antibiotics in the previous 2 years; there was no reduction in consultations in the no antibiotic group (IRR = 1.23, 0.79 to 1.92, P = 0.358) or the delayed antibiotic group (1.19, 0.78 to 1.80, P = 0.426). There was an increase in consultation rate with an information leaflet (IRR = 1.27, 0.86 to 1.87, P = 0.229). Past attendance with cough, or past attendance with other respiratory illness and smoking, also predicted reconsultation with cough. ConclusionDelayed antibiotic prescribing for LRTI appears effective in modifying reconsultation behaviour, particularly in those with a prior history of antibiotic prescription for LRTI. Keywordsanti-bacterial agents; primary health care; referral and consultation; respiratory tract infections. INTRODUCTIONPreliminary evidence in acute sore throat suggests that delayed prescribing may influence future consultation behaviour.Those with a recent history of antibiotic prescribing were much more than twice as likely to reconsult in the year following the index consultation with acute lower respiratory infection (LRTI). They showed substantial (78%) reduction in consultation following delayed prescribing compared with immediate prescribing.Over time, utilising a delayed prescribing strategy is likely to result in sustained reduction in consultation for LRTI. BackgroundAcute respiratory illness is the most common condition managed in primary care, and antibiotics are widely prescribed for LRTI despite limited evidence of benefit.

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Quantitative systematic review of randomised controlled trials comparing antibiotic with placebo for acute cough in adults

Abstract: Objectives: To assess whether antibiotic treatment for acute cough is effective and to measure the side effects of such treatment.

Cited by 136 publications

References 25 publications

Canadian Guidelines for the Management of Acute Exacerbations of Chronic Bronchitis

Canadian Guidelines for the Management of Acute Exacerbations of Chronic Bronchitis

Antibiotics for coughing in general practice: a qualitative decision analysis

Effect of antibiotic prescribing strategies and an information leaflet on longer-term reconsultation for acute lower respiratory tract infection

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