Delayed antibiotic prescriptions for respiratory infections.

Area of Science:

• Evidence-based medicine
• Clinical pharmacology
• Public health

Background:

• Antibiotic overuse for respiratory tract infections (RTIs) raises concerns about adverse reactions, costs, and antimicrobial resistance.
• Delayed antibiotic prescribing, where patients receive a prescription to be filled only if symptoms persist, is a strategy to mitigate these issues.

Purpose of the Study:

• To evaluate the impact of delayed antibiotic prescriptions on clinical outcomes, antibiotic use, antibiotic resistance, and patient satisfaction in RTIs.
• To compare delayed prescribing with immediate prescribing and no antibiotic strategies.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) involving participants of all ages with RTIs.
• Searched multiple databases including CENTRAL, MEDLINE, Embase, CINAHL, Web of Science, and clinical trial registries up to May 2017.
• Included 11 RCTs with 3555 participants, analyzing outcomes such as fever, pain, symptom duration, adverse effects, antibiotic use, and patient satisfaction.

Main Results:

• No significant differences in clinical outcomes for cough between delayed, immediate, and no antibiotic groups.
• Immediate antibiotics showed modest benefits for fever and pain in sore throat and acute otitis media in some studies.
• Delayed antibiotics significantly reduced antibiotic use compared to immediate prescribing (31% vs. 93%) but increased use compared to no antibiotics (28% vs. 14%).
• Patient satisfaction was similar between delayed and immediate antibiotics, and favored delayed over no antibiotics.

Conclusions:

• Delayed antibiotic prescribing effectively reduces antibiotic use for RTIs with comparable clinical outcomes and patient satisfaction to immediate prescribing.
• A strategy of no antibiotics, with advice to return if symptoms worsen, results in the least antibiotic use while maintaining similar outcomes and satisfaction.
• Delayed prescribing serves as a viable compromise to reduce unnecessary antibiotic use and combat antimicrobial resistance when a no-antibiotic strategy is not feasible.