Delayed antibiotic prescribing for respiratory tract infections : Individual patient data meta-analysis
Stuart, Beth L. (University of Southampton (Regne Unit). Faculty of Medicine)
Hounkpatin, Hilda Osafo (University of Southampton (Regne Unit). Faculty of Medicine)
Becque, Taeko (University of Southampton (Regne Unit). Faculty of Medicine)
Yao, Guiqing Lily (University of Leicester (Regne Unit). College of Life Sciences)
Zhu, Shihua (University of Southampton (Regne Unit). Faculty of Medicine)
Alonso-Coello, Pablo (Institut d'Investigació Biomèdica Sant Pau)
Altiner, Attila (Rostock University Medical Center (Alemanya). Institute of General Practice)
Arroll, Bruce (University of Auckland (Nova Zelanda). Department of General Practice and Primary Health Care)
Böhning, Dankmar (University of Southampton (Regne Unit). Southampton Statistical Sciences Research Institute)
Bostock, Jennifer (King's College London (Regne Unit))
Bucher, Heiner (University Hospital Basel (Basilea, Suïssa))
Chao, Jennifer H. (State University of New York Downstate (Nova York))
de la Poza Abad, Mariam (Institut Català de la Salut)
Francis, Nick (University of Southampton (Regne Unit). Faculty of Medicine)
Gillespie, David C. (Cardiff University (Regne Unit). School of Medicine)
Hay, Alastair D. (University of Bristol (Regne Unit). Bristol Medical School)
Kenealy, Timothy (University of Auckland (Nova Zelanda). Department of General Practice and Primary Health Care)
Löffler, Christin (Rostock University Medical Center (Alemanya). Institute of General Practice)
McCormick, David P. (University of Texas Medical Branch at Galveston (Estats Units). Department of Pediatrics)
Mas Dalmau, Gemma (Institut d'Investigació Biomèdica Sant Pau)
Muñoz, Laura (Agència de Qualitat i Avaluació Sanitàries de Catalunya)
Samuel, Kirsty (University of Leeds (Regne Unit). Leeds Institute for Health Sciences)
Moore, Michael (University of Southampton (Regne Unit). Faculty of Medicine)
Little, Paul S. (University of Southampton (Regne Unit). Faculty of Medicine)

Data:	2021
Resum:	AbstractObjective To assess the overall effect of delayed antibiotic prescribing on average symptom severity for patients with respiratory tract infections in the community, and to identify any factors modifying this effect. Design Systematic review and individual patient data meta-analysis. Data sources Cochrane Central Register of Controlled Trials, Ovid Medline, Ovid Embase, EBSCO CINAHL Plus, and Web of Science. Eligibility criteria for study selection Randomised controlled trials and observational cohort studies in a community setting that allowed comparison between delayed versus no antibiotic prescribing, and delayed versus immediate antibiotic prescribing. Main outcome measures The primary outcome was the average symptom severity two to four days after the initial consultation measured on a seven item scale (ranging from normal to as bad as could be). Secondary outcomes were duration of illness after the initial consultation, complications resulting in admission to hospital or death, reconsultation with the same or worsening illness, and patient satisfaction rated on a Likert scale. Results Data were obtained from nine randomised controlled trials and four observational studies, totalling 55 682 patients. No difference was found in follow-up symptom severity (seven point scale) for delayed versus immediate antibiotics (adjusted mean difference -0. 003, 95% confidence interval -0. 12 to 0. 11) or delayed versus no antibiotics (0. 02, -0. 11 to 0. 15). Symptom duration was slightly longer in those given delayed versus immediate antibiotics (11. 4 v 10. 9 days), but was similar for delayed versus no antibiotics. Complications resulting in hospital admission or death were lower with delayed versus no antibiotics (odds ratio 0. 62, 95% confidence interval 0. 30 to 1. 27) and delayed versus immediate antibiotics (0. 78, 0. 53 to 1. 13). A significant reduction in reconsultation rates (odds ratio 0. 72, 95% confidence interval 0. 60 to 0. 87) and an increase in patient satisfaction (adjusted mean difference 0. 09, 0. 06 to 0. 11) were observed in delayed versus no antibiotics. 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. Children younger than 5 years had a slightly higher follow-up symptom severity with delayed antibiotics than with immediate antibiotics (adjusted mean difference 0. 10, 95% confidence interval 0. 03 to 0. 18), but no increased severity was found in the older age group. Conclusions Delayed antibiotic prescribing is a safe and effective strategy for most patients, including those in higher risk subgroups. 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. Study registration PROSPERO CRD42018079400.
Nota:	Altres ajuts: NIHR Research for Patient Benefit (RfPB, grant No PB-PG-0416-20005).
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Anti-Bacterial Agents ; Drug Administration Schedule ; Humans ; Practice Patterns, Physicians' ; Respiratory Tract Infections ; Time-to-Treatment
Publicat a:	The BMJ, Vol. 373 (april 2021) , p. n808, ISSN 1756-1833

DOI: 10.1136/bmj.n808
PMID: 33910882

16 p, 711.5 KB

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