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GPs can safely write delayed antibiotic scripts for RTIs, finds study


Antibiotics


Delayed antibiotic prescribing is ‘safe and effective’ for most patients suffering from respiratory tract infections, including those in higher-risk groups, a study has found. 

Researchers analysed individual patient data from several trials and observational studies, involving 56,000 people, to investigate the effects of delayed antibiotic prescribing, finding no difference in severity of symptoms compared to immediate antibiotics and a similar symptom duration as when no antibiotics are prescribed.

The report, published in the BMJ, said ‘delayed antibiotic prescribing… can be used to help reduce antibiotic use’, which is ‘crucial’ to reduce antimicrobial resistance, particularly in primary care where antibiotics are most prescribed.

Previous clinical trials have also suggested that delayed prescribing for respiratory tract infections is probably safe and effective for most patients, but unlike in this study, were unable to account for subgroups or harms, according to the report. 

The new study, led by researchers at the University of Southampton, measured symptom severity two to four days after the initial consultation on a seven-point scale ranging from ‘normal’ to ‘as bad as could be’. 

They found ‘no difference’ in the severity of symptoms experienced among those given delayed instead of immediate antibiotics.

The report also said: ‘Delayed prescribing was associated with similar symptom duration as no antibiotic prescribing and is unlikely to lead to poorer symptom control than immediate antibiotic prescribing.

‘Delayed prescribing could reduce reconsultation rates and is unlikely to be associated with an increase in symptoms or illness duration, except in young children.’

It found that children younger than five had a slightly higher follow-up symptom severity with delayed antibiotics than with immediate antibiotics. 

The study also found symptoms lasted ‘slightly longer’ in those given delayed instead of immediate antibiotics – 11.4 compared to 10.9 days – but added this was similar for delayed versus no antibiotics. 

Patients were less likely to suffer complications resulting in a hospital admission or death with delayed versus no antibiotics and delayed versus immediate antibiotics, it added. 

Also, where antibiotics were delayed instead of not given, this led to a ‘significant reduction’ in reconsultation rates and led to a higher level of patient satisfaction, the report said.

NICE describes delayed prescribing as offering GPs ‘an alternative to immediate antimicrobial prescribing’, by encouraging self-management as a first step, but allows a person to access antimicrobials without another appointment if their condition gets worse.

According to Public Health England (PHE) figures, antibiotic prescribing in general practice fell by 17% between 2014 and 2018

Meanwhile, a study from last year found that honey is ‘more effective’ than ‘usual’ treatments such as antibiotics to treat symptoms of upper respiratory tract infections (URTIs).