Delayed prescription strategy can reduce antibiotic use

(STEPANOV GRIGORII)

For uncomplicated respiratory infections, strategies that delay the patient's pick-up or use of antibiotics can result in less antibiotic use with equal satisfaction, according to a new study.

Patients who had to go pick up their prescriptions from the primary care office or who delayed taking the antibiotics experienced slightly greater symptoms for a slightly longer time during their illness than people who got antibiotics immediately, but all groups had similar satisfaction levels.

Most respiratory infections, like pharyngitis or bronchitis, are caused by viruses, not bacteria, and antibiotics do not modify the infections significantly. But most patients with symptoms of these infections still receive an antibiotic in the U.S., the authors write.

Using antibiotics when they do little to help puts the patient at risk of unnecessary side effects and helps make the targeted bacteria resistant to the drugs.

The result of the delaying strategies was a "substantial reduction in antibiotic use," said lead author Dr. Pablo Alonso-Coello of the Iberoamerican Cochrane Center in Barcelona, Spain. "Patients assigned to the delayed strategies show similar satisfaction and are less likely to believe in antibiotic effectiveness."

Delayed prescription strategies could be beneficial in Spain and other countries, including the U.S., where antibiotic use is often inappropriate, Alonso-Coello told Reuters Health by email.

The researchers included almost 400 patients with recent-onset uncomplicated respiratory infections from 23 primary care centers in Spain. They were divided into four groups.

Those in the first group received an antibiotic at their first doctor's visit and were instructed to start taking it that same day. In the second group, they received the antibiotic immediately but were told to start taking it only if they felt worse over the next few days.

In the third group, they were told they could collect the antibiotic prescription three days after their first visit at the primary care office.

The fourth group was not given antibiotics.

In the immediate prescription group, 90 percent of people used antibiotics, compared to 32 percent in the patient-led delayed prescription group and 23 percent of those in the prescription collection group.

Severe symptoms lasted an average of 3.6 days for the immediate prescription group, which was 1.5 days less than the patient-led delayed prescription group and about nine hours less than the delayed prescription collection group. Severe symptoms lasted an average of 4.7 days for the no-prescription group.

Perception of general health was similar in all four groups 30 days later, the authors reported in JAMA Internal Medicine.

"Immediate antibiotic prescription increases antimicrobial resistance, strains resources, places patients at risk of adverse effects, and increases the number of future consultations for similar episodes," Alonso-Coello said.

The results from 10 other randomized trials show that delayed prescribing reduces antibiotic use, said Amanda R. McCullough of Bond University in Gold Coast, Australia, who coauthored an editorial appearing alongside the study.

"The novel thing about this study is that they test two different types of delayed prescribing - giving a person an antibiotic prescription with instructions to delay taking it, or telling the person to return to the clinic to get the prescription if still unwell in a given time period," McCullough told Reuters Health by email.

"Antibiotics should not be used for most respiratory infections, because, on average, they do not dramatically improve symptoms," she said.

Antibiotics can shorten the duration of a cough by half a day, but the drugs themselves can cause vomiting, diarrhea and rash, so the harms outweigh the benefits for a respiratory infection, McCullough said.

Clinicians and patients might not feel comfortable in accepting "no antibiotics" as an option, so delayed prescribing is a compromise between completely withholding antibiotics and giving antibiotics immediately, she said.

"It is up to individual doctors, and members of the public, to choose which format of delayed prescribing works best in their healthcare setting," McCullough said.