Reducing antibiotic use for acute bronchitis in primary care: blinded, randomised controlled trial of patient information leaflet

Abstract

Objective: To assess whether sharing the uncertainty of the value of antibiotics for acute bronchitis in the form of written and verbal advice affects the likelihood of patients taking antibiotics.

Design: Nested, single blind, randomised controlled trial.

Setting: Three suburban general practices in Nottingham Participants: 259 previously well adults presenting with acute bronchitis.

Intervention: In group A, 212 patients were judged by their general practitioner not to need antibiotics that day but were given a prescription to use if they got worse and standard verbal reassurance. Half of them (106) were also given an information leaflet. All patients in group B (47) were judged to need antibiotics and were given a prescription and encouraged to use it.

Main outcome measures: Antibiotic use in the next two weeks. Reconsultation for the same symptoms in the next month.

Results: In group A fewer patients who received the information leaflet took antibiotics compared with those who did not receive the leaflet (49 v 63, risk ratio 0.76, 95% confidence interval 0.59 to 0.97, P=0.04). Numbers reconsulting were similar (11 v 14). In group B, 44 patients took the antibiotics.

Conclusion: Most previously well adults with acute bronchitis were judged not to need antibiotics. Reassuring these patients and sharing the uncertainty about prescribing in a information leaflet supported by verbal advice is a safe strategy and reduces antibiotic use.

Figures

Figure 1

Information leaflet given to patients

Figure 2

Flow of patients through whole study and nested trial of information leaflet

Figure 3

Kaplan-Meier plot of number of days between consultation and day of taking antibiotics for those who did and did not receive information leaflet