Delaying Antibiotics Safe and Effective for Respiratory-Tract Infections

By Megan Brooks

May 11, 2021

NEW YORK (Reuters Health) - For most patients with respiratory-tract infections, including those in higher-risk subgroups, it's likely okay to delay antibiotics, according to results of a large meta-analysis with individual patient data.

"Delayed antibiotic prescribing - also known as 'just in case prescribing' - is where patients agree not to collect a prescription immediately and see if symptoms settle to help reduce antibiotic use," a news release accompanying the paper in The BMJ explains.

Clinical trials have suggested that delayed antibiotic prescribing for respiratory-tract infections is probably safe and effective for most patients, but these clinical trials have been underpowered to look at subgroups or harms, and might be subject to selection bias, the authors note in their article.

"This study allowed us to bring together almost all of the data from the studies that contributed to the existing literature. By pooling the data from over 55,000 patients, we were able to look at whether there were particular groups of patients who would benefit from, or be harmed by, a delayed prescription," first author Dr. Beth Stuart with University of Southampton, in the U.K., told Reuters Health by email.

The analysis showed no difference in follow-up symptom severity for delayed versus immediate antibiotics or delayed versus no antibiotics. Symptom duration was slightly longer with delayed versus immediate antibiotics, but was similar for delayed versus no antibiotics.

Complications leading to a hospital stay or death were lower with delayed versus no antibiotics and delayed versus immediate antibiotics. Patient satisfaction was higher and reconsultation rates were lower with delayed antibiotic prescribing.

"The effect of delayed versus immediate antibiotics and delayed versus no antibiotics was not modified by previous duration of illness, fever, comorbidity, or severity of symptoms," the authors report.

Children younger than 5 years had a slightly higher follow-up symptom severity with delayed antibiotics than with immediate antibiotics, but no increased severity was found in older children.

"What we found should be reassuring to patients and clinicians because the results suggest that delayed prescribing should be safe and effective for most patients, even those considered to be at higher risk. It may therefore be a useful approach to antibiotic stewardship and an alternative to an immediate prescription," Dr. Stuart told Reuters Health.

SOURCE: The BMJ, online April 28, 2021.