Journal Article

Optimizing antibiotic prescribing for acute cough in general practice: a cluster-randomized controlled trial

Samuel Coenen, Paul Van Royen, Barbara Michiels and Joke Denekens

in Journal of Antimicrobial Chemotherapy

Published on behalf of British Society for Antimicrobial Chemotherapy

Volume 54, issue 3, pages 661-672
Published in print September 2004 | ISSN: 0305-7453
Published online September 2004 | e-ISSN: 1460-2091 | DOI: http://dx.doi.org/10.1093/jac/dkh374
Optimizing antibiotic prescribing for acute cough in general practice: a cluster-randomized controlled trial

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Objectives: To assess the effect of a tailored professional intervention, including academic detailing, on antibiotic prescribing for acute cough.

Methods: In a cluster-randomized controlled before and after study 85 Flemish GPs included adult patients with acute cough consulting in the periods February–April 2000 and 2001. The intervention consisted of a clinical practice guideline for acute cough, an educational outreach visit and a postal reminder to support its implementation in January 2001. Antibiotic prescribing rates and patients' symptom resolution were the main outcome measures.

Results: Thirty-six of 42 GPs received the intervention and 35 of 43 GPs served as controls; 1503 patients were eligible for analysis. Only in the intervention group were patients less likely to receive antibiotics after the intervention [ORadj (95% CI)=0.56 (0.36–0.87)]. Prescribed antibiotics were also more in line with the guideline in the intervention group [1.90 (0.96–3.75)] and less expensive from the perspective of the National Sickness and Invalidity Insurance Institute {MDadj (95% CI)=–€6.89 [−11.77−(−2.02)]}. No significant differences were found between the groups for the time to symptom resolution.

Conclusions: An (inter)actively delivered tailored intervention implementing a guideline for acute cough is successful in optimizing antibiotic prescribing without affecting patients' symptom resolution. Further research efforts should be devoted to cost-effectiveness studies of such interventions.

Keywords: primary care; respiratory tract infections; guidelines; antibacterials; academic detailing

Journal Article.  8420 words.  Illustrated.

Subjects: Medical Oncology ; Critical Care

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