Symptom response to antibiotic prescribing strategies in acute sore throat in adults: the DESCARTE prospective cohort study in UK general practice

Michael Moore; Beth Stuart; Fd Richard Hobbs; Chris C Butler; Alastair D Hay; John Campbell; Brendan C Delaney; Sue Broomfield; Paula Barratt; Kerenza Hood; Hazel A Everitt; Mark Mullee; Ian Williamson; David Mant; Paul Little; DESCARTE investigators

doi:10.3399/bjgp17X692321

Symptom response to antibiotic prescribing strategies in acute sore throat in adults: the DESCARTE prospective cohort study in UK general practice

Michael Moore, Beth Stuart, Fd Richard Hobbs, Chris C Butler, Alastair D Hay, John Campbell, Brendan C Delaney, Sue Broomfield, Paula Barratt, Kerenza Hood, Hazel A Everitt, Mark Mullee, Ian Williamson, David Mant, Paul Little, DESCARTE investigators

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

14 Citations (Scopus)

Abstract

BACKGROUND: A delayed or 'just in case' prescription has been identified as having potential to reduce antibiotic use in sore throat.

AIM: To determine the symptomatic outcome of acute sore throat in adults according to antibiotic prescription strategy in routine care.

DESIGN AND SETTING: A secondary analysis of the DESCARTE (Decision rule for the Symptoms and Complications of Acute Red Throat in Everyday practice) prospective cohort study comprising adults aged ≥16 years presenting with acute sore throat (≤2 weeks' duration) managed with treatment as usual in primary care in the UK.

METHOD: A random sample of 2876 people from the full cohort were requested to complete a symptom diary. A brief clinical proforma was used to collect symptom severity and examination findings at presentation. Outcome details were collected by notes review and a detailed symptom diary. The primary outcome was poorer 'global' symptom control (defined as longer than the median duration or higher than median symptom severity). Analyses controlled for confounding by indication (propensity to prescribe antibiotics).

RESULTS: A total of 1629/2876 (57%) of those requested returned a symptom diary, of whom 1512 had information on prescribing strategy. The proportion with poorer global symptom control was greater in those not prescribed antibiotics 398/587 (68%) compared with those prescribed immediate antibiotics 441/728 (61%) or delayed antibiotic prescription 116/197 59%); adjusted risk ratio (RR) (95% confidence intervals [CI]): immediate RR 0.87 (95% CI = 0.70 to 0.96), P = 0.006; delayed RR 0.88 (95% CI = 0.78 to 1.00), P = 0.042.

CONCLUSION: In the routine care of adults with sore throat, a delayed antibiotic strategy confers similar symptomatic benefits to immediate antibiotics compared with no antibiotics. If a decision is made to prescribe an antibiotic, a delayed antibiotic strategy is likely to yield similar symptomatic benefit to immediate antibiotics.

Original language	English
Pages (from-to)	e634-e642
Number of pages	9
Journal	British Journal of General Practice
Volume	67
Issue number	662
DOIs	https://doi.org/10.3399/bjgp17X692321
Publication status	Published - 31 Aug 2017

Keywords

Antibiotics
Cohort studies
Delayed prescribing
Sore throat
Symptom control

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Moore, M., Stuart, B., Hobbs, F. R., Butler, C. C., Hay, A. D., Campbell, J., Delaney, B. C., Broomfield, S., Barratt, P., Hood, K., Everitt, H. A., Mullee, M., Williamson, I., Mant, D., Little, P., & DESCARTE investigators (2017). Symptom response to antibiotic prescribing strategies in acute sore throat in adults: the DESCARTE prospective cohort study in UK general practice. British Journal of General Practice, 67(662), e634-e642. https://doi.org/10.3399/bjgp17X692321

@article{2a409583f2ea40c1be1944d13876ca43,

title = "Symptom response to antibiotic prescribing strategies in acute sore throat in adults: the DESCARTE prospective cohort study in UK general practice",

abstract = "BACKGROUND: A delayed or 'just in case' prescription has been identified as having potential to reduce antibiotic use in sore throat.AIM: To determine the symptomatic outcome of acute sore throat in adults according to antibiotic prescription strategy in routine care.DESIGN AND SETTING: A secondary analysis of the DESCARTE (Decision rule for the Symptoms and Complications of Acute Red Throat in Everyday practice) prospective cohort study comprising adults aged ≥16 years presenting with acute sore throat (≤2 weeks' duration) managed with treatment as usual in primary care in the UK.METHOD: A random sample of 2876 people from the full cohort were requested to complete a symptom diary. A brief clinical proforma was used to collect symptom severity and examination findings at presentation. Outcome details were collected by notes review and a detailed symptom diary. The primary outcome was poorer 'global' symptom control (defined as longer than the median duration or higher than median symptom severity). Analyses controlled for confounding by indication (propensity to prescribe antibiotics).RESULTS: A total of 1629/2876 (57%) of those requested returned a symptom diary, of whom 1512 had information on prescribing strategy. The proportion with poorer global symptom control was greater in those not prescribed antibiotics 398/587 (68%) compared with those prescribed immediate antibiotics 441/728 (61%) or delayed antibiotic prescription 116/197 59%); adjusted risk ratio (RR) (95% confidence intervals [CI]): immediate RR 0.87 (95% CI = 0.70 to 0.96), P = 0.006; delayed RR 0.88 (95% CI = 0.78 to 1.00), P = 0.042.CONCLUSION: In the routine care of adults with sore throat, a delayed antibiotic strategy confers similar symptomatic benefits to immediate antibiotics compared with no antibiotics. If a decision is made to prescribe an antibiotic, a delayed antibiotic strategy is likely to yield similar symptomatic benefit to immediate antibiotics.",

keywords = "Antibiotics, Cohort studies, Delayed prescribing, Sore throat, Symptom control",

author = "Michael Moore and Beth Stuart and Hobbs, {Fd Richard} and Butler, {Chris C} and Hay, {Alastair D} and John Campbell and Delaney, {Brendan C} and Sue Broomfield and Paula Barratt and Kerenza Hood and Everitt, {Hazel A} and Mark Mullee and Ian Williamson and David Mant and Paul Little and {DESCARTE investigators}",

note = "{\textcopyright} British Journal of General Practice 2017.",

year = "2017",

month = aug,

day = "31",

doi = "10.3399/bjgp17X692321",

language = "English",

volume = "67",

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journal = "British Journal of General Practice",

issn = "0960-1643",

publisher = "Royal College of General Practitioners",

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Moore, M, Stuart, B, Hobbs, FR, Butler, CC, Hay, AD, Campbell, J, Delaney, BC, Broomfield, S, Barratt, P, Hood, K, Everitt, HA, Mullee, M, Williamson, I, Mant, D, Little, P & DESCARTE investigators 2017, 'Symptom response to antibiotic prescribing strategies in acute sore throat in adults: the DESCARTE prospective cohort study in UK general practice', British Journal of General Practice, vol. 67, no. 662, pp. e634-e642. https://doi.org/10.3399/bjgp17X692321

Symptom response to antibiotic prescribing strategies in acute sore throat in adults: the DESCARTE prospective cohort study in UK general practice. / Moore, Michael; Stuart, Beth; Hobbs, Fd Richard et al.
In: British Journal of General Practice, Vol. 67, No. 662, 31.08.2017, p. e634-e642.

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

TY - JOUR

T1 - Symptom response to antibiotic prescribing strategies in acute sore throat in adults

T2 - the DESCARTE prospective cohort study in UK general practice

AU - Moore, Michael

AU - Stuart, Beth

AU - Hobbs, Fd Richard

AU - Butler, Chris C

AU - Hay, Alastair D

AU - Campbell, John

AU - Delaney, Brendan C

AU - Broomfield, Sue

AU - Barratt, Paula

AU - Hood, Kerenza

AU - Everitt, Hazel A

AU - Mullee, Mark

AU - Williamson, Ian

AU - Mant, David

AU - Little, Paul

AU - DESCARTE investigators

PY - 2017/8/31

Y1 - 2017/8/31

N2 - BACKGROUND: A delayed or 'just in case' prescription has been identified as having potential to reduce antibiotic use in sore throat.AIM: To determine the symptomatic outcome of acute sore throat in adults according to antibiotic prescription strategy in routine care.DESIGN AND SETTING: A secondary analysis of the DESCARTE (Decision rule for the Symptoms and Complications of Acute Red Throat in Everyday practice) prospective cohort study comprising adults aged ≥16 years presenting with acute sore throat (≤2 weeks' duration) managed with treatment as usual in primary care in the UK.METHOD: A random sample of 2876 people from the full cohort were requested to complete a symptom diary. A brief clinical proforma was used to collect symptom severity and examination findings at presentation. Outcome details were collected by notes review and a detailed symptom diary. The primary outcome was poorer 'global' symptom control (defined as longer than the median duration or higher than median symptom severity). Analyses controlled for confounding by indication (propensity to prescribe antibiotics).RESULTS: A total of 1629/2876 (57%) of those requested returned a symptom diary, of whom 1512 had information on prescribing strategy. The proportion with poorer global symptom control was greater in those not prescribed antibiotics 398/587 (68%) compared with those prescribed immediate antibiotics 441/728 (61%) or delayed antibiotic prescription 116/197 59%); adjusted risk ratio (RR) (95% confidence intervals [CI]): immediate RR 0.87 (95% CI = 0.70 to 0.96), P = 0.006; delayed RR 0.88 (95% CI = 0.78 to 1.00), P = 0.042.CONCLUSION: In the routine care of adults with sore throat, a delayed antibiotic strategy confers similar symptomatic benefits to immediate antibiotics compared with no antibiotics. If a decision is made to prescribe an antibiotic, a delayed antibiotic strategy is likely to yield similar symptomatic benefit to immediate antibiotics.

AB - BACKGROUND: A delayed or 'just in case' prescription has been identified as having potential to reduce antibiotic use in sore throat.AIM: To determine the symptomatic outcome of acute sore throat in adults according to antibiotic prescription strategy in routine care.DESIGN AND SETTING: A secondary analysis of the DESCARTE (Decision rule for the Symptoms and Complications of Acute Red Throat in Everyday practice) prospective cohort study comprising adults aged ≥16 years presenting with acute sore throat (≤2 weeks' duration) managed with treatment as usual in primary care in the UK.METHOD: A random sample of 2876 people from the full cohort were requested to complete a symptom diary. A brief clinical proforma was used to collect symptom severity and examination findings at presentation. Outcome details were collected by notes review and a detailed symptom diary. The primary outcome was poorer 'global' symptom control (defined as longer than the median duration or higher than median symptom severity). Analyses controlled for confounding by indication (propensity to prescribe antibiotics).RESULTS: A total of 1629/2876 (57%) of those requested returned a symptom diary, of whom 1512 had information on prescribing strategy. The proportion with poorer global symptom control was greater in those not prescribed antibiotics 398/587 (68%) compared with those prescribed immediate antibiotics 441/728 (61%) or delayed antibiotic prescription 116/197 59%); adjusted risk ratio (RR) (95% confidence intervals [CI]): immediate RR 0.87 (95% CI = 0.70 to 0.96), P = 0.006; delayed RR 0.88 (95% CI = 0.78 to 1.00), P = 0.042.CONCLUSION: In the routine care of adults with sore throat, a delayed antibiotic strategy confers similar symptomatic benefits to immediate antibiotics compared with no antibiotics. If a decision is made to prescribe an antibiotic, a delayed antibiotic strategy is likely to yield similar symptomatic benefit to immediate antibiotics.

KW - Antibiotics

KW - Cohort studies

KW - Delayed prescribing

KW - Sore throat

KW - Symptom control

U2 - 10.3399/bjgp17X692321

DO - 10.3399/bjgp17X692321

M3 - Article (Academic Journal)

C2 - 28808075

SN - 0960-1643

VL - 67

SP - e634-e642

JO - British Journal of General Practice

JF - British Journal of General Practice

IS - 662

ER -

Symptom response to antibiotic prescribing strategies in acute sore throat in adults: the DESCARTE prospective cohort study in UK general practice

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