Prescription Strategies in Acute Uncomplicated Respiratory Infections A Randomized Clinical Trial
Por:
Abad, MD, Dalmau, GM, Bakedano, MM, Gonzalez, AIG, Criado, YC, Anadon, SH, del Campo, RR, Monserrat, PT, Palma, AN, Ortiz, LM, Thio, EB, Llor, C, Little, P, Alonso-Coello, P
Publicada:
1 ene 2016
Resumen:
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 visitwas 6 (6) days. The mean (SD) general health status on first visitwas 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 visitwas similar among the 4 groups. The mean (SD) duration of severe symptomswas 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 symptomswas 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 symptomwas 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.
Filiaciones:
Abad, MD:
Doctor Carles Ribas Primary Care Ctr, Barcelona, Spain
Dalmau, GM:
Biomed Res Inst St Pau, Iberoamer Cochrane Ctr, Barcelona, Spain
Bakedano, MM:
Irurtzun Primary Care Ctr, Irurtzun, Spain
Gonzalez, AIG:
Vicente Muzas Primary Care Ctr, Madrid, Spain
Red Invest Serv Salud Enfermedades Cron, Madrid, Spain
SemFYC, Evidence Based Med Grp, Madrid, Spain
Criado, YC:
Monovar Primary Care Ctr, Madrid, Spain
Anadon, SH:
Jaume I Primary Care Ctr, Tarragona, Spain
del Campo, RR:
SemFYC, Evidence Based Med Grp, Madrid, Spain
Basque Hlth Serv, Kronikgune Grp Knowledge Management, Alza Osakidetza Primary Care Ctr, Madrid, Spain
Monserrat, PT:
Jordi Gol Univ, Inst Res Primary Healthcare, Res Support Unit Metropolitana Nord, Santa Coloma De Gramenet, Spain
El Maresme Primary Care Ctr, Mataro, Spain
Palma, AN:
El Maresme Primary Care Ctr, Mataro, Spain
Ortiz, LM:
Jordi Gol Univ, Inst Res Primary Healthcare, Res Support Unit Metropolitana Nord, Santa Coloma De Gramenet, Spain
Thio, EB:
St Roc Primary Care Ctr, Badalona, Spain
Llor, C:
Via Roma Primary Care Ctr, Barcelona, Spain
Little, P:
Aldermoor Primary Care Ctr, Aldermoor Close, Southampton, Hants, England
Alonso-Coello, P:
SemFYC, Evidence Based Med Grp, Madrid, Spain
CIBER Epidemiol Salud Publ, Madrid, Spain
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