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

Niamh Redmond; Sophie Turnbull; Beth Stuart; Hannah Thornton; Hannah Christensen; Pete Blair; Brendan Delaney; Matthew Thompson; Tim Peters; Alastair Hay; Paul Little

doi:10.3399/bjgp18X698873

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

Niamh Redmond^*, Sophie Turnbull, Beth Stuart, Hannah Thornton, Hannah Christensen, Pete Blair, Brendan Delaney, Matthew Thompson, Tim Peters, Alastair Hay, Paul Little

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

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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.

Original language	English
Pages (from-to)	e682-e693
Number of pages	12
Journal	British Journal of General Practice
Volume	68
Issue number	675
Early online date	27 Sept 2018
DOIs	https://doi.org/10.3399/bjgp18X698873
Publication status	Published - 1 Oct 2018

Research Groups and Themes

BTC (Bristol Trials Centre)
BRTC

Keywords

Adverse outcomes
Antibiotics
Children
Cohort studies
Primary care
Respiratory tract infections

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Redmond, N., Turnbull, S., Stuart, B., Thornton, H., Christensen, H., Blair, P., Delaney, B., Thompson, M., Peters, T., Hay, A., & Little, P. (2018). Impact of antibiotics for children presenting to general practice with cough on adverse outcomes: Secondary analysis from a multicentre prospective cohort study. British Journal of General Practice, 68(675), e682-e693. https://doi.org/10.3399/bjgp18X698873

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

abstract = "BackgroundClinicians 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.",

keywords = "Adverse outcomes, Antibiotics, Children, Cohort studies, Primary care, Respiratory tract infections",

author = "Niamh Redmond and Sophie Turnbull and Beth Stuart and Hannah Thornton and Hannah Christensen and Pete Blair and Brendan Delaney and Matthew Thompson and Tim Peters and Alastair Hay and Paul Little",

year = "2018",

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doi = "10.3399/bjgp18X698873",

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Redmond, N, Turnbull, S, Stuart, B, Thornton, H, Christensen, H , Blair, P, Delaney, B, Thompson, M, Peters, T , Hay, A & Little, P 2018, 'Impact of antibiotics for children presenting to general practice with cough on adverse outcomes: Secondary analysis from a multicentre prospective cohort study', British Journal of General Practice, vol. 68, no. 675, pp. e682-e693. https://doi.org/10.3399/bjgp18X698873

Impact of antibiotics for children presenting to general practice with cough on adverse outcomes: Secondary analysis from a multicentre prospective cohort study. / Redmond, Niamh; Turnbull, Sophie; Stuart, Beth et al.
In: British Journal of General Practice, Vol. 68, No. 675, 01.10.2018, p. e682-e693.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - Impact of antibiotics for children presenting to general practice with cough on adverse outcomes

T2 - Secondary analysis from a multicentre prospective cohort study

AU - Redmond, Niamh

AU - Turnbull, Sophie

AU - Stuart, Beth

AU - Thornton, Hannah

AU - Christensen, Hannah

AU - Blair, Pete

AU - Delaney, Brendan

AU - Thompson, Matthew

AU - Peters, Tim

AU - Hay, Alastair

AU - Little, Paul

PY - 2018/10/1

Y1 - 2018/10/1

N2 - BackgroundClinicians 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.

AB - BackgroundClinicians 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.

KW - Adverse outcomes

KW - Antibiotics

KW - Children

KW - Cohort studies

KW - Primary care

KW - Respiratory tract infections

UR - https://www.scopus.com/pages/publications/85054048647

U2 - 10.3399/bjgp18X698873

DO - 10.3399/bjgp18X698873

M3 - Article (Academic Journal)

C2 - 30201827

AN - SCOPUS:85054048647

SN - 0960-1643

VL - 68

SP - e682-e693

JO - British Journal of General Practice

JF - British Journal of General Practice

IS - 675

ER -

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

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