Little Drawback to Delayed Antibiotics for Respiratory Infections

By Kelly Young

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

For patients with respiratory infections, delaying antibiotics could be a safe way to reduce antibiotic use, according to a study in The BMJ.

Researchers analyzed individual-patient data from nine randomized, controlled trials and four observational studies involving 56,000 pediatric and adult patients with respiratory infections (e.g., the common cold, acute otitis media, sore throats, and upper and lower respiratory infections) in a community setting. Patients who were prescribed an antibiotic but asked not to use it unless they felt worse or failed to improve and those whose clinicians took a watchful-waiting approach were compared with patients given immediate antibiotics or no antibiotics.

Mean symptom severity 2 to 4 days after consultation was not significantly different between delayed antibiotics and immediate or no antibiotics. Time to symptom resolution was about half a day longer with delayed versus immediate antibiotics. Reconsultation rates were lower with delayed versus no antibiotics.

The authors conclude: "Delayed prescribing could be used as a standalone interventional approach, but it might also be a way of resolving mismatched expectations between clinician and patient."