ArticleBMJ (Clinical research ed.)2009
Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries.
Article in BMJ (Clinical research ed.), 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00353951 (Genomics to Combat Resistance Against Antibiotics in Community-Acquired LRTI in Europe), which is not on this map. Cited by 165 papers, 9 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Genomics to Combat Resistance Against Antibiotics in Community-Acquired LRTI in Europe: GRACE. Workpackage 8. An Observational Study of Cough / Lower Respiratory Tract Infection (LRTI) in Primary Care
Who cites it
165 citing papers in PubMed, 9 syntheses or guidelines pooled it.
- A systematic review and meta-analysis on diagnostic accuracy of point-of-care C-reactive protein devices for acute respiratory tract infections.Infection · 2026Pooled it
- Point-of-care tests to manage acute respiratory tract infections in primary care: a systematic review and qualitative synthesis of healthcare professional and patient views.The Journal of antimicrobial chemotherapy · 2025Pooled it
- Biomarkers as point-of-care tests to guide prescription of antibiotics in people with acute respiratory infections in primary care.The Cochrane database of systematic reviews · 2022Pooled it
- Prevalence, aetiologies and prognosis of the symptom cough in primary care: a systematic review and meta-analysis.BMC family practice · 2021Pooled it
- Delayed antibiotic prescribing for respiratory tract infections: individual patient data meta-analysis.BMJ (Clinical research ed.) · 2021Pooled it
- Assessing the potential of upper respiratory tract point-of-care testing: a systematic review of the prognostic significance of upper respiratory tract microbes.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2019Pooled it
- Variation in antibiotic use among and within different settings: a systematic review.The Journal of antimicrobial chemotherapy · 2018Pooled it
- The effect of interventions aiming to optimise the prescription of antibiotics in dental care-A systematic review.PloS one · 2017Pooled it
- How communication affects prescription decisions in consultations for acute illness in children: a systematic review and meta-ethnography.BMC family practice · 2014Pooled it
- Effects of a comprehensive antibiotic stewardship program on antibiotic prescribing for acute respiratory infections in rural facilities: a cluster randomized trial.Nature medicine · 2026Trial
- Trial
- Antibiotic Prescribing for Acute Respiratory Tract Infections 12 Months After Communication and CRP Training: A Randomized Trial.Annals of family medicine · 2019Trial
- Trial
- The social role of C-reactive protein point-of-care testing to guide antibiotic prescription in Northern Thailand.Social science & medicine (1982) · 2018Trial
- Point-of-care urine culture for managing urinary tract infection in primary care: a randomised controlled trial of clinical and cost-effectiveness.The British journal of general practice : the journal of the Royal College of General Practitioners · 2018Trial
- Trial
- Disease Course of Lower Respiratory Tract Infection With a Bacterial Cause.Annals of family medicine · 2016Trial
- Cost effectiveness of amoxicillin for lower respiratory tract infections in primary care: an economic evaluation accounting for the cost of antimicrobial resistance.The British journal of general practice : the journal of the Royal College of General Practitioners · 2016Trial
- Trial
- Trial
105 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
15 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo describe variation in antibiotic prescribing for acute cough in contrasting European settings and the impact on recovery.
designCross sectional observational study with clinicians from 14 primary care research networks in 13 European countries who recorded symptoms on presentation and management. Patients followed up for 28 days with patient diaries.
settingPrimary care.
participantsAdults with a new or worsening cough or clinical presentation suggestive of lower respiratory tract infection.
main outcome measuresPrescribing of antibiotics by clinicians and total symptom severity scores over time.
results3402 patients were recruited (clinicians completed a case report form for 99% (3368) of participants and 80% (2714) returned a symptom diary). Mean symptom severity scores at presentation ranged from 19 (scale range 0 to 100) in networks based in Spain and Italy to 38 in the network based in Sweden. Antibiotic prescribing by networks ranged from 20% to nearly 90% (53% overall), with wide variation in classes of antibiotics prescribed. Amoxicillin was overall the most common antibiotic prescribed, but this ranged from 3% of antibiotics prescribed in the Norwegian network to 83% in the English network. While fluoroquinolones were not prescribed at all in three networks, they were prescribed for 18% in the Milan network. After adjustment for clinical presentation and demographics, considerable differences remained in antibiotic prescribing, ranging from Norway (odds ratio 0.18, 95% confidence interval 0.11 to 0.30) to Slovakia (11.2, 6.20 to 20.27) compared with the overall mean (proportion prescribed: 0.53). The rate of recovery was similar for patients who were and were not prescribed antibiotics (coefficient -0.01, P<0.01) once clinical presentation was taken into account.
conclusionsVariation in clinical presentation does not explain the considerable variation in antibiotic prescribing for acute cough in Europe. Variation in antibiotic prescribing is not associated with clinically important differences in recovery.
trial registrationClinicaltrials.gov NCT00353951.
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