Delayed Antibiotics Prescription may Not Worsen respiratory tract infections: BMJ

Antibiotics are commonly used to treat acute respiratory tract infections, despite studies showing that antibiotics have, at best, modest effects. Guidelines recommend that the fewest number of antibiotic courses should be prescribed for the shortest period possible. However, antibiotics are still being overprescribed. Dr Beth Stuart and his team conducted a study to assess the overall effect of delayed antibiotic prescribing on average symptom severity for patients with respiratory tract infections in the community and to identify any factors modifying this effect.

It was a systematic review and individual patient data meta-analysis in which researchers searched for randomised controlled trials and observational cohort studies in Cochrane Central Register of Controlled Trials, Ovid Medline, Ovid Embase, EBSCO CINAHL Plus, and Web of Science. They included data of 55 682 patients from nine randomised controlled trials and four observational studies. The major outcome assessed was the average symptom severity two to four days after the initial consultation measured on a seven-item scale (ranging from normal to as bad as could be). Researchers also assessed the duration of illness after the initial consultation, complications resulting in admission to hospital or death, reconsultation with the same or worsening illness, and patient satisfaction rated on a Likert scale.

Key findings of the study were:

• Upon analysis, the researchers found no difference in follow-up symptom severity (seven-point scale) for delayed versus immediate antibiotics (adjusted mean difference −0.003) or delayed versus no antibiotics (0.02).
• They found that the symptom duration was slightly longer in those given delayed versus immediate antibiotics (11.4 vs 10.9 days). However, they noted that the symptoms were similar for delayed versus no antibiotics.
• They also noted that complications resulting in hospital admission or death were lower with delayed versus no antibiotics (odds ratio 0.62) and delayed versus immediate antibiotics (0.78).
• They observed a significant reduction in reconsultation rates (odds ratio 0.72) and an increase in patient satisfaction (adjusted mean difference 0.09) in delayed versus no antibiotics.
• They noted that the effect of delayed versus immediate antibiotics and delayed versus no antibiotics was not modified by the previous duration of illness, fever, comorbidity, or severity of symptoms.
• However, they noted that children younger than five had a slightly higher follow-up symptom severity with delayed antibiotics than with immediate antibiotics.

The authors concluded, "Delayed prescribing was associated with similar symptom duration as no antibiotic prescribing and is unlikely to lead to poorer symptom control than immediate antibiotic prescribing."

They further added, "Delayed prescribing could reduce reconsultation rates and is unlikely to be associated with an increase in symptoms or illness duration, except in young children."

For further information:

https://www.bmj.com/content/373/bmj.n808