Delayed antibiotic prescriptions for respiratory infections

Abstract

For many clinical outcomes, there were no differences between prescribing strategies. Symptoms for acute otitis media and sore throat were modestly improved by immediate antibiotics compared with delayed antibiotics. There were no differences in complication rates. Delaying prescribing did not result in significantly different levels of patient satisfaction compared with immediate provision of antibiotics (86% versus 91%) (moderate quality evidence). However, delay was favoured over no antibiotics (87% versus 82%). Delayed antibiotics achieved lower rates of antibiotic use compared to immediate antibiotics (31% versus 93%) (moderate quality evidence). The strategy of no antibiotics further reduced antibiotic use compared to delaying prescription for antibiotics (14% versus 28%). Delayed antibiotics for people with acute respiratory infection reduced antibiotic use compared to immediate antibiotics, but was not shown to be different to no antibiotics in terms of symptom control and disease complications. Where clinicians feel it is safe not to prescribe antibiotics immediately for people with respiratory infections, no antibiotics with advice to return if symptoms do not resolve is likely to result in the least antibiotic use while maintaining similar patient satisfaction and clinical outcomes to delaying prescription of antibiotics. Where clinicians are not confident in using a no antibiotic strategy, a delayed antibiotics strategy may be an acceptable compromise in place of immediate prescribing to significantly reduce unnecessary antibiotic use for RTIs, and thereby reduce antibiotic resistance, while maintaining patient safety and satisfaction levels.Editorial note: As a living systematic review, this review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.

Delayed antibiotics for acute sore throat

“…With respect to the new guidance from the National Institute of Health and Care Excellence on antimicrobial prescribing in acute sore throat,1 we share Rosen’s concern of the growing risk of antibiotic resistance brought about by the “tension between professional judgment and consumer sovereignty.”2 One key negotiating strategy, advocated by NICE1 and a recent Cochrane systematic review,3 is the use of a back-up (or delayed) antibiotic prescription with self care advice for patients with a FeverPAIN score ≥2. In the wider context of antimicrobial stewardship, we urge colleagues to use the excellent TARGET toolkit devised by Public Health England and collaborators 4…”

Irrational Use of Antibiotics in Medicine: Crisis of Antibiotic Resistance and what We Can Do

“…Фебрилитет, вызванный вирусами, может продолжаться в течение различного времени: до 5 сут при младенческой розеоле, до 7 сут -при энтеровирус-ной инфекции, до 14 сут и более -при инфекционном мононуклеозе. Антибиотики, назначенные при вирусной инфекции, не влияют на течение заболевания, не сокра-щают лихорадочный период, не уменьшают риска раз-вития осложнений [7,8]. Эти факты ставят под сомнение обоснованность популярного среди педиатров неписан-ного «правила трех дней»: «три дня высокая температу-ра -надо давать антибиотик».…”

“…Другой эффективной стратегией оказалась отсрочка антибактериальной терапии. Эксперты Сотрудничества Кокрейн исследовали эффект этой стратегии в лече-нии острых инфекций дыхательных путей, в том чис-ле у пациентов с кашлем (бронхит) и болью в горле, а также при инфекциях среднего уха [8]. Был прове-ден анализ 11 исследований, включающих 3555 паци-ентов (детей и взрослых: сравнивались три подхода к лечению -немедленное начало антибиотикотерапии, отсроченное начало и отсутствие антибиотикотерапии.…”

Apocalypse: the end of antibiotics?

“…A different Cochrane review7 looking at the concept of delaying antibiotic prescriptions concluded: ‘Where clinicians feel it is safe not to prescribe antibiotics immediately for people with respiratory infections, no antibiotics with advice to return if symptoms do not resolve is likely to result in the least antibiotic use while maintaining similar patient satisfaction and clinical outcomes to delaying prescription of antibiotics.’…”