title: Delayed antibiotic prescribing and associated antibiotic consumption in adults with acute cough.
abstract: Delayed antibiotic prescribing is promoted as a strategy to reduce antibiotic consumption, but its use and its effect on antibiotic consumption in routine care is poorly described.
  
  
  
  To quantify delayed antibiotic prescribing in adults presenting  in primary care with acute cough/lower respiratory tract infection (LRTI), duration of advised delay, consumption of delayed antibiotics, and factors associated with consumption.
  
  
  
  Prospective observational cohort in general practices in 14 primary care  networks in 13 European countries.
  
  
  
  GPs recorded clinical features and antibiotic prescribing for adults presenting with an acute infective illness with cough as the dominant symptom. Patients recorded their consumption of antibiotics from any source during the 28-day  follow up.
  
  
  
  Two hundred and ten (6.3%) of 3368 patients with usable consultation data were prescribed delayed antibiotics. The median recommended delay period was 3 days. Seventy-five (44.4%) of the 169 with consumption data consumed the antibiotic course and a further  18 (10.7%) took another antibiotic during the study period. 50 (29.6%) started their delayed course on the day of prescription. Clinician diagnosis of upper respiratory tract/viral infection and clinician's perception of patient's wanting antibiotics were associated with less consumption  of the delayed prescription. Patient's wanting antibiotics was associated with greater consumption.
  
  
  
  Delayed antibiotic prescribing was used infrequently for adults presenting in general practice with acute cough/LRTI. When used, the effect on antibiotic  consumption was less than found in most trials. There are opportunities for standardising the intervention and promoting wider uptake.
authors.affiliation: Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff. francisna@cf.ac.uk
authors.forename: Nick A
authors.initials: NA
authors.lastname: Francis
authors.forename: David
authors.initials: D
authors.lastname: Gillespie
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Nuttall
authors.forename: Kerenza
authors.initials: K
authors.lastname: Hood
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.forename: Theo
authors.initials: T
authors.lastname: Verheij
authors.forename: Herman
authors.initials: H
authors.lastname: Goossens
authors.forename: Samuel
authors.initials: S
authors.lastname: Coenen
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Butler
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003371:Cough / Q000188:drug therapy* / Q000382:microbiology; D005060:Europe; D058006:General Practice; D006801:Humans; D055118:Medication Adherence; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D061665:Time-to-Treatment
chemical_list: D000900:Anti-Bacterial Agents