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Impact of antibiotics for children presenting to general practice with cough on adverse outcomes: Secondary analysis from a multicentre prospective cohort study

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)e682-e693
Number of pages12
JournalBritish Journal of General Practice
Volume68
Issue number675
Early online date27 Sep 2018
DOIs
DateSubmitted - 18 May 2018
DateAccepted/In press - 2 Jul 2018
DateE-pub ahead of print - 27 Sep 2018
DatePublished (current) - 1 Oct 2018

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.

    Research areas

  • Adverse outcomes, Antibiotics, Children, Cohort studies, Primary care, Respiratory tract infections

    Structured keywords

  • BRTC

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    Rights statement: This is the final published version of the article (version of record). It first appeared online via Royal College of General Practitioners at https://doi.org/10.3399/bjgp18X698873 . Please refer to any applicable terms of use of the publisher.

    Final published version, 203 KB, PDF document

    Licence: CC BY-NC

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