Is the Delayed Antibiotic Prescribing Strategy Effective for Reducing the Use of Antibiotics? - European Medical Journal
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Is the Delayed Antibiotic Prescribing Strategy Effective for Reducing the Use of Antibiotics?

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EMJ Microbiology 2.1 2021 Feature Image
Authors:
*Carl Llor,1,2 Ana Moragas,3 Josep Cots4
Disclosure:

Llor has received grants from Abbott Diagnostics. Moragas and Cots have declared no conflicts of interest.

Citation
EMJ Microbiol Infect Dis. ;2[1]:24-25. Abstract Review No. AR1.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

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BACKGROUND AND AIMS

Delayed prescription is recommended in international guidance for dealing with uncomplicated respiratory infections. Systematic reviews of delayed prescription, where the patient is advised to wait for at least the expected natural history of the illness before using the prescription, have concluded that the strategy is an effective way of reducing antibiotic use.1 A 2017 Cochrane review including randomised clinical trials found that this strategy was associated with significantly decreased antibiotic use, as 31.0% of the cases admitted to taking the antibiotic, 33.9% when the prescription was patient-led, and 27.7% when this was collected at the centre.2 However, the actual use of antibiotics in current practice might be higher than that reported in clinical trials. The authors assessed whether patients given a delayed prescription filled it or not and, if so, how many days the antibiotic was obtained after the index consultation.

MATERIALS AND METHODS

Patients were recruited from practices in urban primary care centres in Catalonia, Spain. All the participating general practitioners were familiar with the delayed prescribing technique and routinely employed it in their practice. Eligible subjects were those of any age presenting with a sore throat with two Centor criteria and uncomplicated acute bronchitis from September 2018 until March 2020. The recruiting doctor issued an antibiotic prescription during the consultation but advised the patient to use it after 3 days in the case of sore throat and after 7 days for episodes of acute bronchitis, and only in the absence of spontaneous improvement, as suggested by the National Institute for Health and Care Excellence (NICE) guideline.3 Participating general practitioners tracked the information and collected it in the electronic records, and registered whether the patients filled the prescription given and the dispensing date within the first 2 weeks after the index consultation.

RESULTS

A total of 126 patients were given a delayed antibiotic prescription, of which 82 cases corresponded to acute bronchitis. The mean age was 41.2 years (standard deviation: ±10.6 years), with 72 women (57.1%). The prescriptions were never filled in 52 cases (41.0%), but five patients took another antibiotic within the first 2 weeks. Out of 74 patients who did take the delayed prescription, 36 obtained the medication the same day of the visit (48.6%). Only 12 patients obtained the medication based on the instructions given by the doctors (16.2%).

CONCLUSION

The strategy of the delayed antibiotic prescribing resulted in a significant reduction in antibiotic use, but this reduction is not as high as the percentage observed in clinical trials, as only 4/10 were not taking antibiotics. In another study carried out in 13 European countries, 55% of the patients who were offered delayed antibiotic prescribing consumed an antibiotic during the study period.4 Similarly, 30% started taking their delayed antibiotics on the day that they were prescribed. In the authors’ study, this was even worse as only a small percentage of patients obtaining the medication adhered to the doctors’ instructions. This study has several limitations. The authors cannot ensure that all the patients who filled the prescription had taken the medication, which is the most important limitation of this study. The method of delivering the delayed prescription to the patient may also influence how delayed prescriptions are used. Patients were not randomised; however, data on routine prescribing behaviour in everyday clinical practice can only be obtained through observational data, as in this study.

References
Stuart B et al. Delayed antibiotic prescribing for respiratory tract infections: individual patient data meta-analysis. BMJ. 2021;373:n808. Spurling GK et al. Delayed antibiotic prescriptions for respiratory infections. Cochrane Database Syst Rev. 2017;9(9):CD004417. National Institute for Health and Clinical Excellence (NICE). Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care. Clinical guideline 69.2008. Available at: https://www.nice.org.uk/guidance/cg69. Last accessed: 8 July 2021. Francis NA et al. Delayed antibiotic prescribing and associated antibiotic consumption in adults with acute cough. Br J Gen Pract. 2012;62(602):e639-46.