Optimizing antibiotic prescribing for acute cough in general practice: a cluster-randomized controlled trial

J Antimicrob Chemother. 2004 Sep;54(3):661-72. doi: 10.1093/jac/dkh374. Epub 2004 Jul 28.


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.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Anti-Bacterial Agents / economics
  • Anti-Bacterial Agents / therapeutic use*
  • Belgium / epidemiology
  • Cluster Analysis
  • Cough / diagnosis
  • Cough / drug therapy*
  • Cough / epidemiology
  • Data Collection
  • Drug Costs
  • Drug Prescriptions
  • Family Practice
  • Female
  • Guidelines as Topic
  • Humans
  • Male
  • Risk Factors
  • Sample Size
  • Surveys and Questionnaires
  • Treatment Outcome


  • Anti-Bacterial Agents