Prescribing antibiotics: to take or keep for a rainy day?

Forty per cent of adults with acute cough or lower respiratory tract infection prescribed antibiotics for immediate use do not take any of them according to new research – but when antibiotics are not prescribed, some people appear to be self-medicating with drugs from previous illnesses, leading the authors of this study to say that consultations should include a discussion of adherence. To cap it all, adherence to acute antibiotic treatment was not associated with improved recovery, which fits with other evidence, perhaps because most of these illnesses are viral.

The observational study, led by a team from Cardiff University, used information from 13 European countries about 1290 patients who were prescribed antibiotics for immediate use, and 1226 who were prescribed no antibiotics at the index consultation. They found that:

  • Just under 45% of those prescribed antibiotics for immediate use took the entire course.
  • Thirty per cent of those prescribed antibiotics did not take any antibiotics at all in the follow-up period (28 days).
  • Of those not prescribed an antibiotic, about 11% took one during the follow-up period.
  • In total, 282 patients (11.2%) took an antibiotic that had not been prescribed at the index consultation (about half of these had not been prescribed any antibiotics; the rest had been prescribed immediate antibiotics but took a different one).

Discussion during consultations needs to look at the probable effects of treatment, and whether patients will take the antibiotics as prescribed – and what factors influence this decision – as well as the issue of leftovers, conclude the authors.

Francis NA et al. Antibiotics for acute cough: an international observational study of patient adherence in primary care. Br J Gen Pract 2012; 62(599): e429-e437(9)