Delaying antibiotics is safe and effective in respiratory tract infection, analysis concludes

Delayed antibiotic prescribing is safe and effective for most patients with respiratory tract infections, results from a review and meta-analysis published in the BMJ has suggested (28 April 2021)​[1]​.

Researchers analysed individual patient data from nine randomised controlled trials and four observational studies that compared delayed antibiotic prescribing with immediate or no antibiotics prescribed for more than 55,000 patients with respiratory tract infections in the community.

They found no difference in follow-up symptom severity for delayed versus immediate antibiotics (adjusted mean difference -0.003, 95% confidence interval -0.12 to 0.11) or for delayed versus no antibiotics (0.02, -0.11 to 0.15). Subgroup analyses showed the effect of delayed versus immediate or no antibiotics was not modified by previous duration of illness, fever, comorbidity, or severity of symptoms. Children aged under five years may have better symptom control with immediate antibiotics, but this was not clinically significant.

Duration of symptoms was similar among patients given delayed versus no antibiotics, and slightly longer for those given delayed versus immediate antibiotics — 11.4 days compared with 10.9 days.

“Compared with a no prescription approach, delayed prescribing probably reduces re-consultation rates, and therefore the workload of general practitioners, with slightly higher levels of patient satisfaction,” the researchers said.

Beth Stuart, a medical statistician at the University of Southampton and lead author of the study, noted that members of the study’s patient panel were reassured by the results.

“Patients want clinicians to give them clear, simple and effective messages about the self-limiting nature of these illnesses [and] the risks associated with unnecessary antibiotics, but also what to look out for and how to determine when they need to use their delayed prescription,” she said.