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Publication - Professor Alastair Hay

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

    secondary analysis from a multicentre prospective cohort study

    Citation

    Redmond, N, Turnbull, S, Stuart, B, Thornton, H, Christensen, H, Blair, P, Delaney, B, Thompson, M, Peters, T, Hay, A & Little, P, 2018, ‘Impact of antibiotics for children presenting to general practice with cough on adverse outcomes: secondary analysis from a multicentre prospective cohort study’. 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 effect 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 15 years, presenting in primary care across England with acute cough and other respiratory symptoms.
    Method
    We collected baseline clinical characteristics and antibiotic prescribing data, used generalised linear models to estimate the effect of antibiotic prescribing on adverse outcomes within 30 days (subsequent hospitalisations; reconsultation for deterioration), controlling for clustering and clinicians’ propensity to prescribe antibiotics.
    Results
    Sixty-five (0.8%) children were hospitalised and 350 (4%) reconsulted for deterioration. Clinicians prescribed immediate and delayed antibiotics to 2313 (28%) and 771 (9%) respectively. Compared with no antibiotics, there was no clear evidence antibiotics reduced hospitalisations (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 (rather than immediate) antibiotics reduced reconsultations for deterioration (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 acute cough and respiratory symptoms in primary care are not at risk of hospitalisation and antibiotics may not reduce the risk. If an antibiotic is considered, a delayed antibiotic prescription may be preferable as it is likely to reduce reconsultation for deterioration.

    Full details in the University publications repository