Optimizing antibiotic prescribing for acute cough in general practice: a cluster-randomized controlled trial
Abstract
OBJECTIVES: To assess the effect of a tailored professional intervention, including academic detailing, on antibiotic prescribing for acute cough. METHODS: In a cluster-randomized controlled before and after study 85 Flemish GPs included adult patients with acute cough consulting in the periods February-April 2000 and 2001. The intervention consisted of a clinical practice guideline for acute cough, an educational outreach visit and a postal reminder to support its implementation in January 2001. Antibiotic prescribing rates and patients' symptom resolution were the main outcome measures. RESULTS: Thirty-six of 42 GPs received the intervention and 35 of 43 GPs served as controls; 1503 patients were eligible for analysis. Only in the intervention group were patients less likely to receive antibiotics after the intervention [OR(adj) (95% CI)=0.56 (0.36-0.87)]. Prescribed antibiotics were also more in line with the guideline in the intervention group [1.90 (0.96-3.75)] and less expensive from the perspective of the National Sickness and Invalidity Insurance Institute [MD(adj) (95% CI)= Euro -6.89 [-11.77-(-2.02)]]. No significant differences were found between the groups for the time to symptom resolution. CONCLUSIONS: An (inter)actively delivered tailored intervention implementing a guideline for acute cough is successful in optimizing antibiotic prescribing without affecting patients' symptom resolution. Further research efforts should be devoted to cost-effectiveness studies of such interventions.
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The overall risk of bias for Coenen 2004 was unclear (6 unclear risk, 1 high risk).
“Risk of bias overall Unclear risk 6 unclear risk, 1 high risk”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Coenen 2004
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Self-citation
- Authors
- Coenen, S., Van Royen, P., Michiels, B., & Denekens, J.
- Affiliations
- University of Antwerp (BE)
- Corresponding author
- Coenen, Samuel
- Venue
- Journal of Antimicrobial Chemotherapy
- Publisher
- Oxford University Press (OUP)
- Published
- 2004-09-01
- Volume
- 54
- Issue
- 3
- Pages
- 661-672
- ISSN
- 0305-7453 (ISSN-L)
- 1460-2091
- OpenAlex
- W2106918076
- Cited by
- 96
- References
- 56
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 1 · 2023: 4 · 2022: 3 · 2021: 10 · 2020: 4 · 2019: 3 · 2018: 4 · 2016: 3 · 2015: 2 · 2014: 9 · 2013: 6 · 2012: 7
- FWCI
- 6.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Antimicrobial Chemotherapy (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Belgische Federale Overheidsdiensten
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- acute cough, antibiotic prescribing, inappropriate antibiotic use, academic detailing, general practitioners, guideline implementation, educational outreach, symptom resolution, prescription drug costs, primary care
- MeSH terms
- Acute Disease, Adult, Anti-Bacterial Agents, Belgium, Cough, Data Collection, Family Practice, Female, Humans, Male, Drug Prescriptions, Surveys and Questionnaires, Risk Factors, Cluster Analysis, Drug Costs, Treatment Outcome, Guidelines as Topic, Sample Size
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