According to the findings of a clinical trial, delayed prescription strategies are associated with reduced antibiotic use when compared with immediate prescriptions in adults with uncomplicated respiratory tract infections. A Medscape news report indicates that delayed antibiotic prescription is a strategy that involves advising patients to take the prescription only if disease symptoms worsen or fail to improve a few days after the clinician consultation. Though the approach has the potential to reduce antibiotic use, studies have reported conflicting results about its effect on clinical outcomes in uncomplicated respiratory infections, and no data is available for the US.
The researchers aimed to investigate the efficacy and safety of two delayed-prescription strategies in this patient population. A multicenter, open-label, randomized clinical trial was conducted that included 398 adults with acute, uncomplicated respiratory infections. Patients were randomly assigned to one of four strategies: a delayed, patient-led strategy in which patients received an antibiotic prescription but were told to use it only if symptoms worsened or failed to improve within several days, a delayed collection strategy that required patients to collect their prescription from the primary care center 3 days post consultation, an immediate prescription strategy, or a no prescription strategy.
Absenteeism rates were notably lower in the delayed patient-led (25.8%) and delayed collection (21.4%) groups than in the immediate prescription (33.3%) and no prescription (39.8%) groups. Though severe symptoms lasted from 0.4 days to 1.5 days longer in the delayed patient-led, delayed collection, and no prescription groups than in the immediate prescription group, patient satisfaction was high and similar among all four groups, according to Medscape.
The results of the trial also showed that significantly fewer patients in the delayed patient-led, delayed collection, and no prescription groups reported that they would revisit their physician for the same illness.
Mariam de la Poza Abad, MD, and colleagues write, “We found that the delayed strategy groups had slightly greater symptom burden and duration than the immediate prescription group, although the differences were not clinically relevant. Delayed prescription and no prescription strategies notably reduced antibiotic use compared with the immediate prescription group.”
Further, the authors of the study write, “Delayed prescription strategies are a useful approach to management in patients with acute uncomplicated respiratory infections. 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.” The researchers conclude that in cases of uncertainty, delayed strategies should become standard practice as they reduce antibiotic use.