This article is more than 5 years old. Information may no longer be current.

Delayed antibiotic prescription leads to similar symptom severity, duration

Strategies to delay prescriptions for antibiotics were associated with clinically similar symptom duration and burden as well as reduced antibiotic use in patients with respiratory infections, according to data published in JAMA Internal Medicine.

The researchers urged doctors to consider employing the delayed strategies in light of antibiotic overuse.

"Respiratory diseases are one of the most common reasons for consultation with family physicians, the most frequent being rhinitis, pharyngitis and acute bronchitis," Mariam de la Poza Abad, MD, Doctor Carles Ribas Primary Care Center, Barcelona, Spain, and colleagues wrote. "Most respiratory infections are self-limited, and recent systemic reviews have suggested that antibiotics modify the course of most of these infections only slightly."

The researchers noted that 60% of patients who report a sore throat and 71% who present with acute uncomplicated bronchitis will receive a prescription for antibiotics.

"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," de la Poza Abad and colleagues wrote.

They conducted a pragmatic, randomized, multicenter, clinical trial in 23 primary care centers in four regions of Spain from December 2009 to July 2012. Final analysis included 398 patients with acute pharyngitis, rhinosinusitis, acute bronchitis or exacerbation of mild-to-moderate chronic obstructive pulmonary disease.

Patients were randomly assigned to one of four prescription strategies: a no antibiotic strategy, an immediate prescription strategy, a delayed patient-led prescription strategy in which patients received an antibiotic at first consultation, and a delayed prescription collection strategy in which patients could pick up their prescription from their PCP 3 days after their consultation. Symptoms, including fever, discomfort, general pain, changes in everyday life, cough and difficulty sleeping, were assessed for duration and severity, the latter of which was measured using a six-point Likert scale.

The researchers reported that at the first visit, patients indicated a mean symptom duration of 6 days and a mean symptom severity range of 1.8 to 3.5.

Following the visit, results showed mean duration of severe symptoms was 3.6 days for the immediate prescription group and 4.7 days for the no prescription group (P = .02). Median duration of severe symptoms was 3 days for the patient-led prescription group and the prescription collection group.

Median maximum severity for any symptom was 5 for all groups. Additionally, de la Poza Abad and colleagues noted that general health statuses and specific symptom severity was similar among the strategies.

The researchers stated that 12.1% of patients in the no prescription group used antibiotics, compared with 23% of patients in the collection group, 32.6% of patients in the patient-led prescription group and 91.1% of patients in the immediate prescription group. Further, patient satisfaction was both high and similar among the four strategy groups (P = .14).

"Delayed prescription strategies are a useful approach to management in patients with acute uncomplicated respiratory infections," de la Poza Abad and colleagues wrote. "When patients or physicians are concerned about the risk of complications, or when patients expect to be prescribed antibiotics, a delayed antibiotic strategy may be particularly helpful compared with a no prescription strategy. Delayed prescription strategies show high potential for clinical benefit not only in Spain but in other countries, including the United States, where antibiotic use is often inappropriate." – by Chelsea Frajerman Pardes

Disclosures: The authors report no relevant financial disclosures.