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Influence of the duration of penicillin prescriptions on outcomes for acute sore throat in adults: results from the DESCARTE prospective cohort study

Moore, Michael, Stuart, Beth, Hobbs, Richard, Butler, Christopher C., Hay, Alastair, Campbell, John, Delaney, Brendan, Broomfield, Sue, Barratt, Paula, Hood, Kerenza, Everitt, Hazel, Mullee, Mark, Williamson, Ian, Mant, David and Little, Paul 2017. Influence of the duration of penicillin prescriptions on outcomes for acute sore throat in adults: results from the DESCARTE prospective cohort study. British Journal of General Practice 67 (662) , e623-e633. 10.3399/bjgp17X692333

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Background Guidelines recommend 10-day treatment courses for acute sore throat, but shorter courses may be used in practice. Aim To determine whether antibiotic duration predicts adverse outcome of acute sore throat in adults in routine care. Design and setting A secondary analysis of the DESCARTE (Decision rule for the Symptoms and Complications of Acute Red Throat in Everyday practice) prospective cohort study of 12 829 adults presenting in UK general practice with acute sore throat. Method A brief clinical proforma was used to collect symptom severity and examination findings at presentation. Outcomes were collected by notes review, a sample also completed a symptom diary. The primary outcome was re-consultation with new/non-resolving symptoms within 1 month. The secondary outcome was ‘global’ poorer symptom control (longer than the median duration or higher than median severity). Results Antibiotics were prescribed for 62% (7872/12 677) of participants. The most commonly prescribed antibiotic was phenoxymethylpenicillin (76%, 5656/7474) and prescription durations were largely for 5 (20%), 7 (57%), or 10 (22%) days. Compared with 5-day courses, those receiving longer courses were less likely to re-consult with new or non-resolving symptoms (5 days 15.3%, 7 days 13.9%, 10 days 12.2%, 7-day course adjusted risk ratio (RR) 0.92 [95% confidence interval [CI] = 0.76 to 1.11] and 10-days RR 0.86 [95% CI = 0.59 to 1.23]) but these differences did not reach statistical significance. Conclusion In adults prescribed antibiotics for sore throat, the authors cannot rule out a small advantage in terms of reduced re-consultation for a 10-day course of penicillin, but the effect is likely to be small.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Royal College of General Practitioners
ISSN: 0960-1643
Date of First Compliant Deposit: 17 August 2017
Date of Acceptance: 15 May 2017
Last Modified: 15 Aug 2018 15:07

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