Effect of antibiotic prescribing strategies and an information leaflet on longer-term reconsultation for acute lower respiratory tract infection
Effect of antibiotic prescribing strategies and an information leaflet on longer-term reconsultation for acute lower respiratory tract infection
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DOI：
10.3399/bjgp09x472601
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发表时间：
2009-10-01
影响因子：
5.9
通讯作者：
Williamson, Ian
中科院分区：
文献类型：
--
作者：
Moore, Michael;Little, Paul;Williamson, Ian
背景有限的证据表明，延迟处方可能会影响未来的咨询behaviors.AimTo评估抗生素处方策略的影响，在一年后的再咨询与急性下呼吸道感染（LRTI）的介绍。研究设计平衡因子随机试验。设置初级保健。方法807名受试者，年龄>= 3岁，有急性疾病的主要症状是咳嗽，加上痰、胸痛、呼吸困难或喘鸣的至少一种症状或体征。受试者被随机分配至三种处方策略（抗生素、延迟抗生素、无抗生素）和一份说明书。先前的抗生素使用和再咨询进行了评估，病历review.ResultsPatients谁被规定的抗生素咳嗽在过去的2年更有可能重新咨询（发病率比[IRR] = 2.55，95%置信区间[CI] = 1.62至4.01）和使用延迟处方策略与减少在这组的再咨询。在既往抗生素暴露的患者中，无抗生素组的就诊率降低了34%（IRR = 0.66，0.30 - 1.44，P = 0.295），延迟抗生素组的就诊率降低了78%（IRR = 0.22，0.10 - 0.49，P
BackgroundLimited 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