Delayed Antibiotics Prescription May Not Worsen Respiratory
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Reducing unnecessary and inappropriate use of antibiotics is crucial to reduce antimicrobial resistance, particularly in primary care where antibiotics are most prescribed. A recent study suggests that delayed antibiotic prescribing is a safe and effective strategy for most patients, including those in higher-risk subgroups.

The 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. 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. 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 for delayed versus immediate antibiotics or delayed versus no antibiotics.

• They found that the symptom duration was slightly longer in those given delayed versus immediate antibiotics. 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 and delayed versus immediate antibiotics.

• They observed a significant reduction in reconsultation rates and an increase in patient satisfaction 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."

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