Reducing antibiotic use for acute bronchitis in primary care: blinded, randomised controlled trial of patient information leaflet

Objective To assess whether sharing the uncertainty of the value of antibiotics for acute bronchitis in the form of written and verbal advice affects the likelihood of patients taking antibiotics. Design Nested, single blind, randomised controlled trial. Setting Three suburban general practices in Nottingham. Participants 259 previously well adults presenting with acute bronchitis. Intervention 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 standard verbal reassurance. Half of them (106) were also given an information leaflet. All patients inn group B (47) were judged to need antibiotics and were given a prescription and encouraged to use it. Main outcome measures Antibiotic use in the next two weeks. Reconsultation for the same symptoms in the next month. Results In group A fewer patients who received the information leaflet took antibiotics compared with those who did not receive the leaflet (49 v 63, risk ratio 0.76, 95% confidence interval 0.59 to 0.97, P=0.04). Numbers reconsulting were similar (11 v 14). In group B, 44 patients took the antibiotics. Conclusion Most previously well adults with acute bronchitis were judged not to need antibiotics. Reassuring these patients and sharing the uncertainty about prescribing in a information leaflet supported by verbal advice is a safe strategy and reduces antibiotic use.