Acute pharyngitis
Conditions
Interventions
Immediate antibiotic prescription strategy group:Immediate prescription of antibiotics
Usual care strategy group:No prescription of antibiotics
Delayed antibiotic prescription strategy group:Delayed prescription of antibiotics
Sponsors
Peking University
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Overall: The study will recruit outpatients aged over 18 years who are diagnosed with pharyngitis, sinusitis, acute bronchitis, or acute exacerbation of chronic obstructive pulmonary disease (COPD). For all enrolled patients, if the doctor has no clear reason to prescribe antibiotics, the patient will be included in the study. 2. Acute pharyngitis: Adult patients whose main symptom is sore throat and who meet 2 or 3 of the Centor criteria: tonsillar enlargement or exudate; temperature above 38°C; tender anterior cervical lymphadenopathy; absence of cough. 3. Sinusitis: Acute inflammation of the nasal and pharyngeal mucosa lasting more than one week; primarily presenting with rhinitis and at least one symptom or sign of sinus involvement: purulent nasal discharge or tenderness in the sinus area. 4. Acute bronchitis: Adult patients with uncomplicated acute bronchitis, primarily presenting with cough, and at least one lower respiratory tract symptom or sign: sputum production, chest pain, shortness of breath, or wheezing. 5. Acute exacerbation of chronic bronchitis / mild to moderate COPD exacerbation: Patients over 40 years old who are smokers or former smokers with at least a 10 pack-year history, and who meet one of the following two diagnoses: chronic bronchitis (cough lasting more than 3 months for over 2 consecutive years), or mild to moderate COPD diagnosed via pulmonary function tests within the past 2 years (post-bronchodilator FEV1/FVC = 50%), accompanied by infective exacerbation and one or more of the Anthonisen criteria: increased sputum volume and/or shortness of breath and/or purulent sputum.
Exclusion criteria
Exclusion criteria: 1. General: Previously participated in delayed prescription strategy trials; pregnancy; the doctor believes the patient's condition is severe or the severe condition has persisted for more than a week (frequent); the patient's symptoms or signs indicate a serious infection and/or complications; the patient has comorbidities with a risk of serious outcomes, including heart, lung, kidney, liver, or neuromuscular diseases, immunosuppression, etc.; patients over 65 years old who meet two or more of the following criteria, or patients over 80 years old who meet one or more of the following criteria: hospitalization in the previous year, type I or II diabetes, history of heart failure, currently taking oral corticosteroids. 2. Acute pharyngitis: sore throat caused by other reasons (such as ulcers, canker sores, or thrush); meets all four Centor criteria; meets only one or none of the Centor criteria; general poor condition; immunocompromised patients; used antibacterial drugs within two weeks; history of rheumatic fever; recurrent pharyngitis (more than 5 episodes in the past year); pregnant women and/or received rapid streptococcal antigen testing at the time of visit. 3. Sinusitis: symptoms lasting less than one week; general poor condition; used antibacterial drugs within two weeks and/or received rapid C-reactive protein testing at the time of visit. 4. Acute bronchitis: clinically suspected pneumonia; bronchial asthma; other acute or chronic respiratory diseases excluding mild to moderate chronic obstructive pulmonary disease (bronchiectasis, pulmonary tuberculosis, etc.); cardiovascular disease; diagnosed psychiatric patients; dementia; general poor condition; living in a care facility; used antibacterial drugs within two weeks; history of hospitalization for respiratory infection in the past year and/or received rapid C-reactive protein testing at the time of visit. 5. Exacerbation of chronic bronchitis/mild to moderate chronic obstructive pulmonary disease: cough with purulent sputum; no pulmonary function test in the past two years; severe chronic obstructive pulmonary disease (FEV1 <50%); tumor; pregnancy; post-tracheostomy; general poor condition; used antibacterial drugs within two weeks; clinically suspected pneumonia (and/or received rapid C-reactive protein testing at the time of visit).
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Symptoms duration; | — |
Secondary
| Measure | Time frame |
|---|---|
| unscheduled health care encounters within 30 days;Antibiotic prescription;Infection-related complications occurring within 30 days;Belief in antibiotics;Satisfaction;Symptoms severity; | — |
Countries
China
Contacts
Public ContactHaishaerjiang Wushouer
Peking University
Outcome results
None listed