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New diagnostic tool could cut acute cough antibiotic scripts, finds study

A new tool for predicting the course of an acute cough in primary care could help reduce antibiotic prescriptions, researchers have found.

The newly developed RISSC85 tool outperforms other tools for predicting the outcome of acute cough and could be useful for helping GPs to cut down on antibiotic prescribing, they claimed.

The study, carried out by researchers in the UK and Belgium, looked at data from a European database for just over 2,600 patients who had presented to primary care with an acute cough. Around 20% of these patients experienced a poor outcome, defined as re-consultation or hospital admission.

The authors used modelling to look for variables that were significant in predicting a poor outcome and included them in the tool.

They found that although the performance of RISSC85 was suboptimal, with a positive predictive value of 27%, it still performed better than existing prognostic prediction tools, such as the PSI and CRB65 tools, at separating patients who were and were not at risk of poor outcome.

The variables they included in the tool were baseline risk of poor outcome, how much the cough was interfering with daily activities, number of years since the patient had stopped smoking, severity of sputum as assessed by the patient, presence of crackles, and blood pressure. Adding factors such as CRP levels, blood nitrogen urea levels and chest X-ray findings did not significantly improve the performance of the tool.

They authors also suggested that as the tool had a negative predictive value of 86%, it could be useful for reassuring patients that their cough was not clinically significant and for reducing antibiotic prescriptions.

They said in the paper: ‘GPs could use the simplified RISSC85 to differentiate between patients where a "wait and see approach" is appropriate, and careful reassurance is the preferred treatment strategy, and those more at risk for poor outcome, who could then be more explicitly advised about key symptoms and signs that require re-consultation, and possibly offered a delayed prescription.’

Public Health England announced ambitions to cut the amount of antibiotics prescribed by GPs over the next two years after it found that one in five antibiotic prescriptions was ‘inappropriate’.

Br J Gen Pract 2017; available online April 9th 

 

Readers' comments (6)

  • Negative predictive value of 86%
    Positive predictive value of 27%

    Great!!! I see litigation

    I hope they make AE and Walk in centres use it

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  • 22% reduction in abx prescriptions when GPs are trained in complementary medicines like Homeopathy.
    http://blogs.bmj.com/bmjopen/2018/03/19/surgeries-employing-gps-with-additional-training-in-complementary-medicine-appear-less-likely-to-prescribe-antibiotics/

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  • interesting, not quite robust enough yet for my liking,though might look at it to see how much of it the patients could self-complete in waiting room before they come in especially as we've got a diy bp machine

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  • David Banner

    When the GMC announces that this tool guarantees 100% absolution of blame when the patient later succumbs to sepsis, I’ll use it.

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  • Phew cough guidance
    Phew cough

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  • Here's an idea :
    why don't Public Health reduce the use of antibiotics in Public Health, and leave GPs to do what is best in General Practice?

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