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Publication - Professor Alastair Hay

    The impact of antibiotics for children presenting to general practice with cough on adverse outcomes

    Citation

    Redmond, N, Turnbull, S, Stuart, B, Thornton, H, Christensen, H, Blair, P, Delaney, B, Thompson, M, Peters, T, Hay, A & Little, P, 2018, ‘The impact of antibiotics for children presenting to general practice with cough on adverse outcomes’. British Journal of General Practice.

    Abstract

    Background
    Clinicians commonly prescribe antibiotics to prevent major adverse outcomes in children presenting in primary care with cough and respiratory symptoms, despite limited meaningful evidence of impact on these outcomes.

    Aim
    To estimate the impact of children’s antibiotic prescribing on adverse outcomes within 30 days of initial consultation.

    Design and Setting
    Secondary analysis of 8320 children in a multi-centre prospective cohort study, aged 3 months to under 16 years, presenting in primary care with acute cough and other respiratory symptoms across England.

    Method
    We collected baseline clinical characteristics and antibiotic prescribing data, used generalised linear models to estimate the impact of antibiotic prescribing on adverse outcomes within 30 days (subsequent hospitalisations; reconsultation with deterioration), controlling for clustering and clinicians’ propensity to prescribe antibiotics.

    Results
    Sixty-five (0.8%) children were hospitalised and 350 (4%) reconsulted with deterioration. Clinicians prescribed immediate and delayed antibiotics to 2313 (28%) and 771 (9%) respectively. Compared with no antibiotics, antibiotics reduced hospitalisations but no clear evidence of benefit was found (immediate antibiotic risk ratio (RR) 0.83, 95% CI: 0.47-1.45; delayed RR 0.70, 95% CI: 0.26-1.90, overall p=0.44). There was evidence that delayed antibiotics reduced reconsultations for worsening symptoms (immediate RR 0.82, 95% CI: 0.65-1.07; delayed RR 0.55, 95% CI: 0.34-0.88, overall p=0.024).

    Conclusion
    Most children presenting with cough in primary care are not at risk of admission and antibiotics probably don’t meaningfully reduce the risk. If an antibiotic is considered, a delayed antibiotic prescription may be preferable as it is likely to reduce reconsultation with worsening illness.

    Full details in the University publications repository