Antibiotic use lower with delayed antibiotic prescriptions than with immediate antibiotic provision

By Melanie Hinze

Asking patients to delay filling their antibiotic prescriptions is one of the most effective strategies for reducing unnecessary antibiotic use, an Australian expert has told Medicine Today.

Associate Professor Geoff Spurling, NHMRC Emerging Leadership Fellow at the General Practice Clinical Unit, University of Queensland and GP at the Inala Indigenous Health Service, Brisbane, said doctors sometimes found it hard not to prescribe antibiotics to people presenting with respiratory tract infections (RTIs) even though the evidence was clear that there would be little or no benefit, and there were clearly harms.

Associate Professor Spurling was lead author of a Cochrane Database of Systematic Review intervention review that aimed to evaluate the effects of delayed antibiotic prescriptions on patient clinical outcomes, antibiotic use, antibiotic resistance and patient satisfaction.

To do this the team compared randomised controlled trials of prescribing strategies, including delayed antibiotic prescriptions, immediate prescription and no prescription. They defined delayed antibiotics as advice to delay filling the antibiotic prescription by at least 48 hours.

Twelve studies including 3750 patients were analysed. Patients had acute RTIs, including otitis media (three studies), streptococcal pharyngitis (three studies), cough (two studies), sore throat (one study), common cold (one study) and a variety of RTIs (two studies). Six studies included children only, two included adults only and four included both adults and children.

The review found that if a doctor provided an immediate script for antibiotics, 93% of scripts on average would be filled. If a doctor provided a script for antibiotics with instructions to delay, only 29% of people would fill the script. If the doctor did not prescribe antibiotics, only 13% would subsequently source and fill a script for antibiotics.

Associate Professor Spurling said all these strategies had patient satisfaction levels over 80%, but for delayed antibiotics satisfaction was slightly higher than for no antibiotics.

‘These findings are based on meta-analyses of all the randomised controlled trials conducted with all the rigor of a Cochrane Systematic Review, so the findings represent the highest level of evidence,’ Associate Professor Spurling said.

He added that unnecessary antibiotic use was costly, risked side effects and contributed to antibiotic resistance.

‘The take home message for GPs who feel it is safe not to prescribe antibiotics immediately, but don’t feel confident saying no, is that a delayed antibiotic prescription will result in a greatly reduced amount of antibiotics being taken, while maintaining patient satisfaction and not compromising patient safety,’ he concluded.

Cochrane Database Syst Rev 2023; Issue 10 Art. No: CD004417.