Table 4GRADE profile – outcomes

The effectiveness of delayed antibiotic prescribing and/or no prescribing as strategies for managing acute cough/acute bronchitis Summary of findings

OutcomeNo. of studies (total patients)DesignInterventionbControlcRelative riskQuality
Collection of antibiotic prescriptiona [D]1 (187)RCTDelayed
43/95 (45%)
Immediate
92/92 (100%)
0.45 (0.36, 0.56)High
Use of antibiotics [L]1 (390)RCTDelayed
39/197 (20%)
Immediate
185/193 (96%)
0.20 (0.15, 0.27)High
Use of antibiotics [L]1 (375)RCTNo AB
29/182 (16%)
Immediate
185/193 (96%)
0.16 (0.11, 0.23)High
Use of antibiotics [L]1 (379)RCTNo AB
29/182 (16%)
Delayed
39/197 (20%)
0.80 (0.52, 1.24)High
OutcomeNo. of studies (total patients)DesignInterventionbControlcMean differenceQuality
Symptom duratione (cough) [D]1 (148)RCTDelayed unknownImmediate unknownLog-rank [Mantel-Haenszel] test (result not reported), with p value > 0.4Moderate
Symptom durationg (cough) [L]1 (426)RCTDelayed
214
No antibiotic
212
Mean difference = 0.75 (−0.37, 1.88) p = 0.19High
Symptom durationg (cough) [L]1 (426)RCTImmediate
214
No antibiotic
212
Mean difference = 0.11 (−1.01, 1.24) p = 0.19High
Symptom durationg (cough) [L]1 (428)RCTImmediate
214
Delayed
214
Mean difference = −0.46 (−1.76, 0.48) p = 0.265High
OutcomeNo. of studies (total patients)DesignInterventionbControlcMean differenceQuality
Adjusted severity of symptomsh[L]1 (426)RCTDelayed
214
No antibiotic
212
Adjusted mean difference = −0.02
p = 0.86
High
Adjusted severity of symptomsh[L]1 (426)RCTImmediate
214
No antibiotic
212
Adjusted mean difference = −0.07
p = 0.49
High
OutcomeNo. of studies (total patients)DesignInterventionbControlcOdds ratioQuality
Diarrhoea [L]1 (426)RCTDelayedNo antibiotic0.17 (0.67, 2.03)High
Diarrhoea [L]1 (426)RCTImmediateNo antibiotic1.22 (0.70, 2.12)High
OutcomeNo. of studies (total patients)DesignInterventionbControlcRelative riskQuality
Re-attendance within 1 month [L]1 (389)RCTDelayed
24/199 (12%)
No antibiotic
41/190 (22%)
0.55 (0.35, 0.88)High
Re-attendance within 1 month [L]1 (386)RCTImmediate
26/196 (13%)
No antibiotic
41/190 (22%)
0.61 (0.39, 0.96)High
Re-attendance within 1 month [L]1 (395)RCTDelayed
24/199 (12%)
Immediate
26/196 (13%)
0.90 (0.54, 1.52)High
OutcomeNo. of studies (total patients)DesignInterventionbControlcRelative riskQuality
Belief antibiotics are effective [L]1 (306)RCTDelayed
57/141 (40%)
Immediate
123/165 (75%)
0.54 (0.43, 0.67)High
Belief antibiotics are effective [L]1 (296)RCTNo AB
61/131 (47%)
Immediate
123/165 (75%)
0.62 (0.50, 0.76)High
Belief antibiotics are effective [L]1 (272)RCTNo AB
61/131 (47%)
Delayed
57/141 (40%)
1.15 (0.87, 1.51)High
OutcomeNo. of studies (total patients)DesignInterventionbControlcRelative riskQuality
Patient satisfactioni[D]1 (148)RCTDelayed
40/73 (54%)
Immediate
55/75 (73%)
0.74 (0.58, 0.95)High
Patient satisfactionk[L]1 (384)RCTDelayed
147/190 (77%)
Immediate
166/194 (86%)
0.90 (0.82, 0.99)High
Patient satisfactionk [L]1 (375)RCTNo antibiotic
130/181 (72%)
Immediate
166/194 (86%)
0.83 (0.75, 0.93)High
Patient satisfactionk [L]1 (371)RCTNo antibiotic
130/181 (72%)
Delayed
147/190 (77%)
0.92 (0.82, 1.04)High
a

rates of consumption unknown

b

intervention = delayed antibiotics

c

control = immediate antibiotics

e

probability of recovery from cough over days 1 to 13

g

duration of cough – days (until very little problem)

h

on a point scale 0 to 6 on six symptoms (adjusted on baseline variables): cough, dyspnoea, sputum production, wellbeing, sleep disturbance, activity disturbance

i

‘very satisfied’ with the consultation

k

‘very satisfied’ with overall management.

From: 2, Evidence review and recommendations

Cover of Respiratory Tract Infections - Antibiotic Prescribing
Respiratory Tract Infections - Antibiotic Prescribing: Prescribing of Antibiotics for Self-Limiting Respiratory Tract Infections in Adults and Children in Primary Care.
NICE Clinical Guidelines, No. 69.
Centre for Clinical Practice at NICE (UK).
Copyright © 2008, National Institute for Health and Clinical Excellence.

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