Prescription Strategies in Acute Uncomplicated Respiratory Infections : A Randomized Clinical Trial
IMPORTANCE: Delayed antibiotic prescription helps to reduce antibiotic use with reasonable symptom control. There are different strategies of delayed prescription, but it is not yet clear which one is the most effective.
OBJECTIVE: To determine the efficacy and safety of 2 delayed strategies in acute, uncomplicated respiratory infections.
DESIGN, SETTING, AND PARTICIPANTS: We recruited 405 adults with acute, uncomplicated respiratory infections from 23 primary care centers in Spain to participate in a pragmatic, open-label, randomized clinical trial.
INTERVENTIONS: Patients were randomized to 1 of 4 potential prescription strategies: (1) a delayed patient-led prescription strategy; (2) a delayed prescription collection strategy requiring patients to collect their prescription from the primary care center; (3) an immediate prescription strategy; or (4) a no antibiotic strategy. Delayed prescription strategies consist of prescribing an antibiotic to take only if the symptoms worsen or if there is no improvement several days after the medical visit.
MAIN OUTCOMES AND MEASURES: The primary outcomes were the duration of symptoms and severity of symptoms. Each symptom was scored using a 6-point Likert scale (scores of 3 or 4 were considered moderate; 5 or 6, severe). Secondary outcomes included antibiotic use, patient satisfaction, and patients' beliefs in the effectiveness of antibiotics.
RESULTS: A total of 405 patients were recruited, 398 of whom were included in the analysis; 136 patients (34.2%) were men; mean (SD) age, 45 (17) years. The mean severity of symptoms ranged from 1.8 to 3.5 points on the Likert scale, and mean (SD) duration of symptoms described on first visit was 6 (6) days. The mean (SD) general health status on first visit was 54 (20) based on a scale with 0 indicating worst health status; 100, best status. Overall, 314 patients (80.1%) were nonsmokers, and 372 patients (93.5%) did not have a respiratory comorbidity. The presence of symptoms on first visit was similar among the 4 groups. The mean (SD) duration of severe symptoms was 3.6 (3.3) days for the immediate prescription group and 4.7 (3.6) days for the no prescription group. The median (interquartile range [IQR]) of severe symptoms was 3 (1-4) days for the prescription collection group and 3 (2-6) days for the patient-led prescription group. The median (IQR) of the maximum severity for any symptom was 5 (3-5) for the immediate prescription group and the prescription collection group; 5 (4-5) for the patient-led prescription group; and 5 (4-6) for the no prescription group. Patients randomized to the no prescription strategy or to either of the delayed strategies used fewer antibiotics and less frequently believed in antibiotic effectiveness. Satisfaction was similar across groups.
CONCLUSIONS AND RELEVANCE: Delayed strategies were associated with slightly greater but clinically similar symptom burden and duration and also with substantially reduced antibiotic use when compared with an immediate strategy.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01363531.
| Errataetall: |
CommentIn: JAMA Intern Med. 2016 Jan;176(1):29-30. - PMID 26720207 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2016 |
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| Erschienen: |
2016 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:176 |
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| Enthalten in: |
JAMA internal medicine - 176(2016), 1 vom: 30. Jan., Seite 21-9 |
| Sprache: |
Englisch |
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| Links: |
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| Themen: |
Anti-Bacterial Agents |
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| Anmerkungen: |
Date Completed 11.05.2016 Date Revised 22.02.2018 published: Print ClinicalTrials.gov: NCT01363531 CommentIn: JAMA Intern Med. 2016 Jan;176(1):29-30. - PMID 26720207 Citation Status MEDLINE |
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| doi: |
10.1001/jamainternmed.2015.7088 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM256043914 |
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| 245 | 1 | 0 | |a Prescription Strategies in Acute Uncomplicated Respiratory Infections |b A Randomized Clinical Trial |
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| 500 | |a ClinicalTrials.gov: NCT01363531 | ||
| 500 | |a CommentIn: JAMA Intern Med. 2016 Jan;176(1):29-30. - PMID 26720207 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a IMPORTANCE: Delayed antibiotic prescription helps to reduce antibiotic use with reasonable symptom control. There are different strategies of delayed prescription, but it is not yet clear which one is the most effective | ||
| 520 | |a OBJECTIVE: To determine the efficacy and safety of 2 delayed strategies in acute, uncomplicated respiratory infections | ||
| 520 | |a DESIGN, SETTING, AND PARTICIPANTS: We recruited 405 adults with acute, uncomplicated respiratory infections from 23 primary care centers in Spain to participate in a pragmatic, open-label, randomized clinical trial | ||
| 520 | |a INTERVENTIONS: Patients were randomized to 1 of 4 potential prescription strategies: (1) a delayed patient-led prescription strategy; (2) a delayed prescription collection strategy requiring patients to collect their prescription from the primary care center; (3) an immediate prescription strategy; or (4) a no antibiotic strategy. Delayed prescription strategies consist of prescribing an antibiotic to take only if the symptoms worsen or if there is no improvement several days after the medical visit | ||
| 520 | |a MAIN OUTCOMES AND MEASURES: The primary outcomes were the duration of symptoms and severity of symptoms. Each symptom was scored using a 6-point Likert scale (scores of 3 or 4 were considered moderate; 5 or 6, severe). Secondary outcomes included antibiotic use, patient satisfaction, and patients' beliefs in the effectiveness of antibiotics | ||
| 520 | |a RESULTS: A total of 405 patients were recruited, 398 of whom were included in the analysis; 136 patients (34.2%) were men; mean (SD) age, 45 (17) years. The mean severity of symptoms ranged from 1.8 to 3.5 points on the Likert scale, and mean (SD) duration of symptoms described on first visit was 6 (6) days. The mean (SD) general health status on first visit was 54 (20) based on a scale with 0 indicating worst health status; 100, best status. Overall, 314 patients (80.1%) were nonsmokers, and 372 patients (93.5%) did not have a respiratory comorbidity. The presence of symptoms on first visit was similar among the 4 groups. The mean (SD) duration of severe symptoms was 3.6 (3.3) days for the immediate prescription group and 4.7 (3.6) days for the no prescription group. The median (interquartile range [IQR]) of severe symptoms was 3 (1-4) days for the prescription collection group and 3 (2-6) days for the patient-led prescription group. The median (IQR) of the maximum severity for any symptom was 5 (3-5) for the immediate prescription group and the prescription collection group; 5 (4-5) for the patient-led prescription group; and 5 (4-6) for the no prescription group. Patients randomized to the no prescription strategy or to either of the delayed strategies used fewer antibiotics and less frequently believed in antibiotic effectiveness. Satisfaction was similar across groups | ||
| 520 | |a CONCLUSIONS AND RELEVANCE: Delayed strategies were associated with slightly greater but clinically similar symptom burden and duration and also with substantially reduced antibiotic use when compared with an immediate strategy | ||
| 520 | |a TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01363531 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Pragmatic Clinical Trial | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
| 700 | 1 | |a Mas Dalmau, Gemma |e verfasserin |4 aut | |
| 700 | 1 | |a Moreno Bakedano, Mikel |e verfasserin |4 aut | |
| 700 | 1 | |a González González, Ana Isabel |e verfasserin |4 aut | |
| 700 | 1 | |a Canellas Criado, Yolanda |e verfasserin |4 aut | |
| 700 | 1 | |a Hernández Anadón, Silvia |e verfasserin |4 aut | |
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| 700 | 1 | |a Martínez Villamar, Lorena |e investigator |4 oth | |
| 700 | 1 | |a Gich, Ignasi |e investigator |4 oth | |
| 700 | 1 | |a Mas Dalmau, Gemma |e investigator |4 oth | |
| 700 | 1 | |a De la Poza Abad, Mariam |e investigator |4 oth | |
| 700 | 1 | |a Liroz Navarro, Mercedes |e investigator |4 oth | |
| 700 | 1 | |a Borrell Thió, Eulàlia |e investigator |4 oth | |
| 700 | 1 | |a Barrera Aguilera, Núria |e investigator |4 oth | |
| 700 | 1 | |a Coll Perona, Maite |e investigator |4 oth | |
| 700 | 1 | |a Libre Saló, Assumpta |e investigator |4 oth | |
| 700 | 1 | |a Cañibano Gómez, Marta |e investigator |4 oth | |
| 700 | 1 | |a Sierra Pujante, Silvia |e investigator |4 oth | |
| 700 | 1 | |a Besa Castellà, Marta |e investigator |4 oth | |
| 700 | 1 | |a Baquero, Marisol Miguel |e investigator |4 oth | |
| 700 | 1 | |a Alsina Casalduero, Maria |e investigator |4 oth | |
| 700 | 1 | |a Serras Ricart, Enric |e investigator |4 oth | |
| 700 | 1 | |a Bertran Fontelles, Victòria |e investigator |4 oth | |
| 700 | 1 | |a Torán Monserrat, Pere |e investigator |4 oth | |
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