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Delayed prescription reduces antibiotic use, increases respiratory infection symptoms
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Delayed treatment for uncomplicated respiratory infections reduced antibiotic use at the cost of a slight increase in symptom severity among patients, according to a recently published study.
“Most respiratory infections are self-limiting, and recent systematic reviews have suggested that antibiotics modify the course of most of these infections only slightly,” the researchers wrote. “Nevertheless, in the United States, about 60% of patients with a sore throat and 71% of patients with acute uncomplicated bronchitis still receive an antibiotic prescription. Overprescription of antibiotics not only increases resistance to these drugs but also strains resources, places patients at risk of adverse effects and increases the number of future consultations for similar episodes.”
To determine the impact of delayed antibiotic strategies, researchers recruited 405 Spanish adults with uncomplicated respiratory infections to one of four treatment strategies from December 2009 to July 2012. These strategies included immediate prescription; delayed patient-led prescription, where patients received antibiotics upon their first consultation; delayed prescription collection, where patients collected antibiotics at their primary care reception desk 3 days after their first consultation; and no prescription. The primary study outcomes were symptom duration and severity, as reported by patients using a six-point Likert scale. The researchers also collected data on secondary outcomes, including overall antibiotic prescription, impact on work or daily activities, patient satisfaction and opinions on antibiotic effectiveness.
Among the 398 patients included in the analysis, the most common infections were pharyngitis (46.2%) and acute bronchitis (32.2%). Approximately four-fifths were nonsmokers, and 93.5% did not have any respiratory comorbidities.
On average, both severe and moderate illness symptoms were less persistent among patients treated immediately than those who did not receive a prescription, or had either form of delayed prescription. Symptom severity was similar across all groups. The researchers documented antibiotic use in 91.1% of patients in the immediate treatment group, 32.6% of patients in the patient-led prescription group, 23% of patients in the prescription collection group and 12.1% of patients in the nonprescription group. Absenteeism was lowest among the two delayed prescription groups, and belief that antibiotics had no effect or were not very effective was most common in the immediate prescription group.
“Delayed strategies were associated with slightly greater, but clinically similar, symptom burden and duration, as well as substantially reduced antibiotic use when compared with an immediate prescription strategy,” the researchers wrote. “In case of uncertainty, delayed strategies should become standard practice as they reduce antibiotic usage and patient belief in antibiotic effectiveness.”
In a related editorial, Amanda R. McCullough, PhD, and Paul P. Glasziou, PhD, both affiliated with the Centre for Research in Evidence-Based Practice at Bond University, Gold Coast, Australia, wrote that these findings are in line with other studies on delayed antibiotic prescription. They advocated its use in light of the diagnostic uncertainty often facing clinicians.
“Acute respiratory infections are usually self-limiting, but clinicians fear missing complications and perceive that prescribing antibiotics is safer than not prescribing,” they wrote. “Delayed prescribing allows clinicians to fulfill their role to do something for their patients, while balancing their concerns about complications against the threat of antibiotic resistance, adverse reactions and out-of-pocket costs for patients.” – by Dave Muoio
Disclosure: The researchers report no relevant financial disclosures.
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