An RCT enrolled 807 patients presenting in a primary care setting with acute uncomplicated lower respiratory tract infection 1. Patients with pneumonic crepitation or systemic features (high fever, vomiting, severe diarrhea) or other concomitant lung diseases were excluded. Three prescription strategies were compared: immediate antibiotics (n = 262), a delayed antibiotic prescription, with advice to use a course of antibiotics available on request if symptoms were not resolved after 14 days (n = 272), and no offer of antibiotics (n = 273). Compared with the immediate antibiotic group, fewer patients in the delayed and control groups used antibiotics (96%, 20%, and 16%, respectively; P<.001). Compared with no offer of antibiotics, other strategies did not alter cough duration (delayed, 0.75 days longer; 95% confidence intervals [CI], -0.37 to 1.88; immediate, 0.11 days longer; 95% CI, -1.01 to 1.24) or other primary outcomes. ). There were lower reattendances within a month with antibiotics (mean attendances for no antibiotics, 0.19; delayed, 0.12; and immediate, 0.11).
191 adult patients with uncomplicated cough in 22 Scottish practices who would have received antibiotics under the GP's usual practice were randomised to receive either an immediate prescription or a delayed prescription (for a week) 2. Patients who appeared toxic and those with a strong preference for antibiotics were excluded. Of the subjects in the delayed arm, 55% did not pick up their prescription. There was no significant difference in the recovery from cough or other recorded symptoms. Although most patients were satisfied, more patients in the immediate arm were very satisfied with the treatment (P = 0.001) and the consultation (P = 0.03).
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