General practitioners prescribe antibiotics to three-quarters of UK adults with acute bronchitis each year, even though there is little evidence to justify it. Yet, a study in this week's BMJ finds that reassuring these patients and sharing the uncertainty about prescribing in an information leaflet reduces antibiotic use.
In this study, over 250 adults with acute bronchitis were divided into two groups. In group A, 212 patients were judged by their general practitioner not to need antibiotics that day, but were given a prescription to use if they got worse and verbal reassurance. Half of them were also given a simple information leaflet. All 47 patients in group B were judged to need antibiotics that day and were given a prescription and encouraged to use it, and nearly all did.
The patient information leaflet reduced the use of antibiotics by nearly a quarter. If these results are extrapolated to national figures, about 750,000 fewer courses of antibiotics could be prescribed each year, say the authors.
Of course some patients with acute respiratory illness do benefit from antibiotics and should receive them, say the authors. But for the many patients (around 80%) for whom the general practitioner thinks that antibiotics are not needed, we have shown that sharing uncertainty about prescribing openly and honestly with the patient is safe and effective and reduces antibiotic use, they conclude.