Impact of antibiotics for children presenting to general practice with cough on adverse outcomes: secondary analysis from a multicentre prospective cohort study

BackgroundClinicians commonly prescribe antibiotics to prevent major adverse outcomes in children presenting in primary care with cough and respiratory symptoms, despite limited meaningful evidence of impact on these outcomes.AimTo estimate the effect of children’s antibiotic prescribing on adverse outcomes within 30 days of initial consultation.Design and settingSecondary analysis of 8320 children in a multicentre prospective cohort study, aged 3 months to <16 years, presenting in primary care across England with acute cough and other respiratory symptoms.MethodBaseline clinical characteristics and antibiotic prescribing data were collected, and generalised linear models were used to estimate the effect of antibiotic prescribing on adverse outcomes within 30 days (subsequent hospitalisations and reconsultation for deterioration), controlling for clustering and clinicians’ propensity to prescribe antibiotics.ResultsSixty-five (0.8%) children were hospitalised and 350 (4%) reconsulted for deterioration. Clinicians prescribed immediate and delayed antibiotics to 2313 (28%) and 771 (9%), respectively. Compared with no antibiotics, there was no clear evidence that antibiotics reduced hospitalisations (immediate antibiotic risk ratio [RR] 0.83, 95% confidence interval [CI] = 0.47 to 1.45; delayed RR 0.70, 95% CI = 0.26 to 1.90, overall P = 0.44). There was evidence that delayed (rather than immediate) antibiotics reduced reconsultations for deterioration (immediate RR 0.82, 95% CI = 0.65 to 1.07; delayed RR 0.55, 95% CI = 0.34 to 0.88, overall P = 0.024).ConclusionMost children presenting with acute cough and respiratory symptoms in primary care are not at risk of hospitalisation, and antibiotics may not reduce the risk. If an antibiotic is considered, a delayed antibiotic prescription may be preferable as it is likely to reduce reconsultation for deterioration.

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Faculty Opinions recommendation of Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1090146.543362 ◽

2007 ◽

Author(s):

Marilyn Roberts

Keyword(s):

Primary Care ◽

Antibiotic Resistance ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Antibiotic Prescribing

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The duration of acute cough in pre-school children presenting to primary care: a prospective cohort study

Family Practice ◽

10.1093/fampra/cmg613 ◽

2003 ◽

Vol 20 (6) ◽

pp. 696-705 ◽

Cited By ~ 79

Author(s):

A. D Hay

Keyword(s):

Primary Care ◽

Cohort Study ◽

Prospective Cohort Study ◽

School Children ◽

Prospective Cohort ◽

Acute Cough

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Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study

BMJ ◽

10.1136/bmj.39274.647465.be ◽

2007 ◽

Vol 335 (7617) ◽

pp. 429 ◽

Cited By ~ 77

Author(s):

Angela Chung ◽

Rafael Perera ◽

Angela B Brueggemann ◽

Abdel E Elamin ◽

Anthony Harnden ◽

...

Keyword(s):

Primary Care ◽

Antibiotic Resistance ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Antibiotic Prescribing

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Relationship between microbiology of throat swab and clinical course among primary care patients with acute cough: a prospective cohort study

Family Practice ◽

10.1093/fampra/cmz093 ◽

2019 ◽

Vol 37 (3) ◽

pp. 332-339

Author(s):

José M Ordóñez-Mena ◽

Thomas R Fanshawe ◽

Chris C Butler ◽

David Mant ◽

Denise Longhurst ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Acute Cough ◽

Severe Problem ◽

Duration Of Symptoms ◽

Presenting Symptoms ◽

Severity Scores ◽

Tract Infections

Abstract Background Acute lower respiratory tract infections (ALRTIs) account for most antibiotics prescribed in primary care despite lack of efficacy, partly due to clinician uncertainty about aetiology and patient concerns about illness course. Nucleic acid amplification tests could assist antibiotic targeting. Methods In this prospective cohort study, 645 patients presenting to primary care with acute cough and suspected ALRTI, provided throat swabs at baseline. These were tested for respiratory pathogens by real-time polymerase chain reaction and classified as having a respiratory virus, bacteria, both or neither. Three hundred fifty-four participants scored the symptoms severity daily for 1 week in a diary (0 = absent to 4 = severe problem). Results Organisms were identified in 346/645 (53.6%) participants. There were differences in the prevalence of seven symptoms between the organism groups at baseline. Those with a virus alone, and those with both virus and bacteria, had higher average severity scores of all symptoms combined during the week of follow-up than those in whom no organisms were detected [adjusted mean differences 0.204 (95% confidence interval 0.010 to 0.398) and 0.348 (0.098 to 0.598), respectively]. There were no differences in the duration of symptoms rated as moderate or severe between organism groups. Conclusions Differences in presenting symptoms and symptoms severity can be identified between patients with viruses and bacteria identified on throat swabs. The magnitude of these differences is unlikely to influence management. Most patients had mild symptoms at 7 days regardless of aetiology, which could inform patients about likely symptom duration.

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Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study

Yearbook of Pediatrics ◽

10.1016/s0084-3954(08)79170-x ◽

2009 ◽

Vol 2009 ◽

pp. 258-260

Author(s):

J.A. Stockman

Keyword(s):

Primary Care ◽

Antibiotic Resistance ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Antibiotic Prescribing

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Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study

Yearbook of Dermatology and Dermatologic Surgery ◽

10.1016/s0093-3619(08)70764-0 ◽

2008 ◽

Vol 2008 ◽

pp. 118-119

Author(s):

B.H. Thiers

Keyword(s):

Primary Care ◽

Antibiotic Resistance ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Antibiotic Prescribing

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Predictive value of the neutrophil to lymphocyte ratio for disease deterioration and serious adverse outcomes in patients with COVID-19: a prospective cohort study

BMC Infectious Diseases ◽

10.1186/s12879-021-05796-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhi-Yong Zeng ◽

Shao-Dan Feng ◽

Gong-Ping Chen ◽

Jiang-Nan Wu

Keyword(s):

Cohort Study ◽

Hospital Admission ◽

Clinical Outcomes ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Characteristic Curve ◽

Adverse Outcomes ◽

Neutrophil To Lymphocyte Ratio ◽

Predictive Values ◽

Lymphocyte Ratio

Abstract Background Early identification of patients who are at high risk of poor clinical outcomes is of great importance in saving the lives of patients with novel coronavirus disease 2019 (COVID-19) in the context of limited medical resources. Objective To evaluate the value of the neutrophil to lymphocyte ratio (NLR), calculated at hospital admission and in isolation, for the prediction of the subsequent presence of disease progression and serious clinical outcomes (e.g., shock, death). Methods We designed a prospective cohort study of 352 hospitalized patients with COVID-19 between January 9 and February 26, 2020, in Yichang City, Hubei Province. Patients with an NLR equal to or higher than the cutoff value derived from the receiver operating characteristic curve method were classified as the exposed group. The primary outcome was disease deterioration, defined as an increase of the clinical disease severity classification during hospitalization (e.g., moderate to severe/critical; severe to critical). The secondary outcomes were shock and death during the treatment. Results During the follow-up period, 51 (14.5%) patients’ conditions deteriorated, 15 patients (4.3%) had complicated septic shock, and 15 patients (4.3%) died. The NLR was higher in patients with deterioration than in those without deterioration (median: 5.33 vs. 2.14, P < 0.001), and higher in patients with serious clinical outcomes than in those without serious clinical outcomes (shock vs. no shock: 6.19 vs. 2.25, P < 0.001; death vs. survival: 7.19 vs. 2.25, P < 0.001). The NLR measured at hospital admission had high value in predicting subsequent disease deterioration, shock and death (all the areas under the curve > 0.80). The sensitivity of an NLR ≥ 2.6937 for predicting subsequent disease deterioration, shock and death was 82.0% (95% confidence interval, 69.0 to 91.0), 93.3% (68.0 to 100), and 92.9% (66.0 to 100), and the corresponding negative predictive values were 95.7% (93.0 to 99.2), 99.5% (98.6 to 100) and 99.5% (98.6 to 100), respectively. Conclusions The NLR measured at admission and in isolation can be used to effectively predict the subsequent presence of disease deterioration and serious clinical outcomes in patients with COVID-19.

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