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Qualitative interview study of antibiotics and self-management strategies for respiratory infections in primary care
  1. Lisa McDermott1,
  2. Geraldine M Leydon2,
  3. Amy Halls2,
  4. Jo Kelly2,
  5. Amanda Nagle2,
  6. Jennifer White2,
  7. Paul Little2
  8. The PIPS investigators
  1. 1 Department of Primary Care and Public Health Sciences, King’s College London, London, UK
  2. 2 Department of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
  1. Paul Little,
  2. Ian Williamson,
  3. Mike Moore,
  4. Mark Mullee,
  5. Jo Kelly,
  6. Julie Hooper,
  7. Lisa McDermott,
  8. Geraldine Leydon,
  9. Ben Holdstock-Brown,
  10. Amanda Nagle,
  11. Jennifer White
  1. Correspondence to Professor Geraldine M Leydon; gerry{at}


Objective To explore perceptions of illness, the decisions to consult and the acceptability of delayed antibiotic prescriptions and self-help treatments for respiratory tract infections (RTIs).

Design Qualitative semistructured interview study.

Setting UK primary care.

Participants 20 adult patients who had been participating in the ‘PIPS’ (Pragmatic Ibuprofen Paracetamol and Steam) trial in the South of England.

Method Semistructured telephone interviews were conducted with participants to explore their experiences and views on various treatments for RTI.

Results Participants had concerns about symptoms that were not clinically serious and were mostly unaware of the natural history of RTIs, but were aware of the limitations of antibiotics and did not expect them with every consultation. Most viewed delayed prescriptions positively and had no strong preference over which technique is used to deliver the delayed antibiotic, but some patients received mixed messages, such as being told their infection was viral then being given an antibiotic, or were sceptical about the rationale. Participants disliked self-help treatments that involved taking medication and were particularly concerned about painkillers in combination. Steam inhalation was viewed as only moderately helpful for mild symptoms.

Conclusion Delayed prescribing is acceptable no matter how the delay is operationalised, but explanation of the rationale is needed and care taken to minimise mixed messages about the severity of illnesses and causation by viruses or bacteria. Better access is needed to good natural history information, and the signs and symptoms requiring or not requiring general practitioner advice. Significant concerns about paracetamol, ibuprofen and steam inhalation are likely to need careful exploration in the consultation.

  • antibiotics
  • prescribing
  • respiratory tract infection
  • self-help

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  • LMD and GML contributed equally.

  • Contributors GML led the qualitative work as part of the PIPs trial. PL secured research funding and acted as overall PI of the PIPs trial. JK facilitated recruitment. LMcD, AN and JW collected interview data. All authors were involved in/commented on data analysis (led by GML and LMcD). AH and GML developed the manuscript, to which all authors contributed.

  • Funding This article presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (grant ref no. RP-PG-0407-10098). Thanks to NIHR Post Doctoral Fellowship for funding GML during this work (grant ref no. NIHR/PDF-2009-02-35).

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Ethics approval The study was approved by Southampton and Southwest MREC number 06/Q1702/154.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

  • Collaborators University of Southampton: Paul Little, Ian Williamson, Mike Moore, Mark Mullee, Jo Kelly, Julie Hooper, Lisa McDermott, Geraldine Leydon, Ben Holdstock-Brown (medical student at the time), Amanda Nagle (medical student at the time), Jennifer White (medical student at the time); Samantha Hall Patient and Public (PPI) representative.