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Delayed Antibiotic Prescribing Safe for Respiratory Tract Infection

THURSDAY, April 29, 2021 -- For patients with respiratory tract infections, delayed antibiotic prescribing seems to be a safe and effective strategy, according to a review published online April 28 in The BMJ.

Beth Stuart, Ph.D., from the University of Southampton in the United Kingdom, and colleagues conducted a systematic review and individual patient data meta-analysis to examine the overall effect of delayed antibiotic prescribing on average symptom severity for patients with respiratory tract infections in the community. Data were included from nine randomized controlled trials and four observational studies with a total of 55,682 patients.

The researchers found that for delayed versus immediate antibiotics or for delayed versus no antibiotics, there were no differences in follow-up symptom severity. Symptom duration was similar for delayed versus no antibiotics and was slightly longer in those given delayed versus immediate antibiotics. Complications resulting in hospital admission or death were lower, but not significantly so, for delayed versus no antibiotics and for delayed versus immediate antibiotics. In delayed versus no antibiotics, there was a significant reduction in reconsultation rates and a significant increase in patient satisfaction. Previous duration of illness, fever, comorbidity, and severity of symptoms did not modify the effect of delayed versus immediate antibiotics or delayed versus no antibiotics.

"Delayed prescribing appears to be a safe and effective antibiotic strategy for most patients, including those in higher risk subgroups," the authors write. "Delayed prescribing could be used as a standalone interventional approach, but it might also be a way of resolving mismatched expectations between clinician and patient."

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