LONDON (Reuters Health) – Offering reassurance and education to patients about the uncertain benefit of antibiotics in cases of acute bronchitis can reduce the rate of antibiotic usage, according to British investigators.
Dr. John Macfarlane, of the Nottingham City Hospital, and associates examined 259 patients presenting with bronchitis of no more than 21 days duration. Forty-seven patients were judged to need treatment and were urged to fill a prescription for antibiotics. Forty-four did so.
The remaining 212 patients did not appear to need antibiotics, Dr. Macfarlane's group reports in the British Medical Journal for January 12. The patients were reassured that their condition did not require treatment at that time and that it would likely resolve on its own. However, all were given a prescription for antibiotics to use if they felt their symptoms worsened. Half of these patients also received an information leaflet describing the natural course of lower respiratory tract symptoms and the risks and benefits of antibiotic usage.
Among those given verbal reassurance but no leaflet, 62% took their antibiotics within the following 2 weeks. In comparison, 47% who received the leaflet used their prescriptions, a significant difference (p = 0.04).
"Most patients seemed happy with the approach [and few] expressed concern about sharing the prescribing decision with their doctor," the investigators write.
In a commentary, Dr. Chris van Weel, of the University Medical Centre St. Radboud in Nijmegen, Netherlands, praises the strategy, writing that it "takes away the power struggle between the patient and the general practitioner…and focuses the patient's decision on the content of the advice."
However, Dr. van Weel suggests that even fewer antibiotics would be used if prescriptions were not dispensed at initial presentation unless absolutely necessary and patients were encouraged to return if symptoms did not resolve.
In response, Dr. Macfarlane told Reuters Health that, while this latter approach would be effective, most general practitioners would avoid it because it involves increased effort on the part of both the physician and the patient.
"So we chose this more practical and pragmatic approach," he added.
"What we want to do next is see if a single intervention of shared decision making and providing more information to the patient would alter long-term consulting behavior," Dr. Macfarlane noted. "We expect that patients would become more self-reliant and more comfortable in dealing with nonserious symptoms on their own."
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