Delayed antibiotics for respiratory infections

Spurling, Geoffrey K. P., Del Mar, Chris B., Dooley, Liz and Foxlee, Ruth (2007) Delayed antibiotics for respiratory infections. Cochrane Database of Systematic Reviews, 3 CD004417: 1-55. doi:10.1002/14651858.CD004417.pub3

Author Spurling, Geoffrey K. P.
Del Mar, Chris B.
Dooley, Liz
Foxlee, Ruth
Title Delayed antibiotics for respiratory infections
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2007
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD004417.pub3
Volume 3
Issue CD004417
Start page 1
End page 55
Total pages 55
Place of publication Oxford, United Kingdom
Publisher John Wiley & Sons
Language eng
Subject 11 Medical and Health Sciences
Formatted abstract
Previous reviews indicate that antibiotics have, at best, only modest benefit for acute respiratory tract infections (ARTIs). These benefits need to be balanced against adverse effects, costs, and the risk of bacteria becoming resistant to antibiotics. One way for doctors to reduce the use of antibiotics is to prescribe delayed, (meaning providing the prescription, but advising the patient/carer to delay their use in the hope that symptoms resolve first). Delayed prescribing resulted in 32% of patients using antibiotics compared to 93% of patients in the immediate prescription group. However, not prescribing antibiotics at all results in the least antibiotic prescribing (14% of patients used antibiotics).

While this review found 10 studies looking at prescribing strategies for respiratory infections, it was generally not possible to combine results from different studies because of incomplete information from some studies and the different types of patients in each study. There were only three trials comparing the strategies of delayed and no antibiotics.

For most symptoms like fever, pain and malaise, there was no difference between immediate, delayed and no antibiotics. The only differences were small and favoured immediate antibiotics for relieving pain and fever for sore throat and pain and malaise for middle ear infections. There was little difference in adverse effects of antibiotics for the three prescribing strategies and no significant difference in complication rates.

Patient satisfaction was slightly reduced in the delayed antibiotic group (87% satisfied) compared to the immediate antibiotic group (92% satisfied). Satisfaction rates were similar between delayed and no antibiotic groups (83% satisfied).

When doctors feel it is safe not to prescribe antibiotics immediately, prescribing none with advice to return if symptoms do not resolve rather than delaying them will result in lower subsequent antibiotic use, while maintaining similar patient satisfaction and symptom outcomes.
Keyword Medicine, General & Internal
Randomized Controlled-trial
Acute Otitis-media
Hemolytic Streptococcal Pharyngitis
Prescribing Strategies
Tract Infection
Prescriptions Reduce
Sore Throat
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 32 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 51 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Mon, 18 Feb 2008, 14:26:05 EST