URTI: Delayed Antibiotic Prescribing Increases Risk of Hospital Admission

Sarfaroj Khan 

July 20, 2020

Takeaway

  • In patients with upper respiratory tract infection (URTI), delayed antibiotic prescribing is associated with an increased risk of infection-related hospital admissions and repeat antibiotic prescribing.

Why this matters

  • Treatment guidelines and the Cochrane review provide limited recommendations on when to use delayed antibiotic prescribing.

  • Findings suggest that delayed antibiotic should be targeted only to patients with lower risks of complications and immediate antibiotic to those with higher risks.

Study design

  • Two-population based studies used data from the UK Clinical Practice Research Datalink (CPRD) and the Secure Anonymised Information Linkage (SAIL) databases and included 1.82 million patients with an URTI and antibiotic prescription.

  • Primary outcome: infection-related hospital admissions in the 30 days after the antibiotic prescription.

  • Funding: None disclosed.

Key results

  • The frequency of delayed antibiotic prescribing was 8.3% in CPRD and 9.2% in SAIL.

  • The incidence of infection-related hospital admissions in the 30 days after the antibiotic prescription was 0.15 and 0.67 per 100 person-months in CPRD (3247 cases) and SAIL (4242 cases), respectively.

  • Delayed antibiotic prescription was associated with an increased risk of infection-related hospital admissions combining the results of both datasets (adjusted HR, 1.52; 95% CI, 1.43-1.62).

  • The probability of delayed prescribing was unrelated to patient risks of being admitted to the hospital for infection-related complications.

  • Analyses of number needed to harm (NNH) with delayed antibiotic prescription showed considerable variation across different patient groups (median NNH with delayed antibiotic prescribing: 1357, 2.5% percentile 295 and 97.5% percentile 3366).

Limitations

  • Patients were not randomised to different antibiotic strategies.

  • Risk of bias and confounding.

 

van Staa TP, Palin V, Brown B, Welfare W, Li Y, Ashcroft DM. The safety of delayed versus immediate antibiotic prescribing for upper respiratory tract infections. Clin Infect Dis. 2020 Jun 29 [Epub ahead of print]. doi: 10.1093/cid/ciaa890. PMID: 32594104 Abstract.

This clinical summary first appeared on Univadis, part of the Medscape Professional Network.

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