Reducing antibiotic use for acute bronchitis in primary care: blinded, randomised controlled trial of patient information leaflet.
OBJECTIVE
To assess whether sharing the uncertainty of the value of antibiotics for acute bronchitis in the form of written and verbal advice affects the likelihood of patients taking antibiotics.


METHODS
Nested, single blind, randomised controlled trial.


METHODS
Three suburban general practices in Nottingham Participants: 259 previously well adults presenting with acute bronchitis.


METHODS
In group A, 212 patients were judged by their general practitioner not to need antibiotics that day but were given a prescription to use if they got worse and standard verbal reassurance. Half of them (106) were also given an information leaflet. All patients in group B (47) were judged to need antibiotics and were given a prescription and encouraged to use it.


METHODS
Antibiotic use in the next two weeks. Reconsultation for the same symptoms in the next month.


RESULTS
In group A fewer patients who received the information leaflet took antibiotics compared with those who did not receive the leaflet (49 v 63, risk ratio 0.76, 95% confidence interval 0.59 to 0.97, P=0.04). Numbers reconsulting were similar (11 v 14). In group B, 44 patients took the antibiotics.


CONCLUSIONS
Most previously well adults with acute bronchitis were judged not to need antibiotics. Reassuring these patients and sharing the uncertainty about prescribing in a information leaflet supported by verbal advice is a safe strategy and reduces antibiotic use.
Macfarlane
John
J
Respiratory Medicine, Nottingham City Hospital. john.macfarlane@tinyworld.co.uk
Holmes
William
W
Gard
Philip
P
Thornhill
David
D
Macfarlane
Rosamund
R
Hubbard
Richard
R
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001991:Bronchitis / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004363:Drug Utilization; D005194:Family Practice / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D012646:Self Administration; D016037:Single-Blind Method; D019564:Unnecessary Procedures
D000900:Anti-Bacterial Agents