Review: delaying a prescription reduces antibiotic use in upper respiratory tract infections

摘要

Antibiotic resistance is an important public health concern and is linked to antibiotic prescribing. In response, several approaches have been implemented to enhance appropriate prescribing of these drugs, particularly in primary healthcare settings.' the systematic review by Arroll et al examined the few existing RCTs that have assessed the effect of delayed prescriptions for URTIs. No new trials have been published on the effect of delayed prescriptions since this review was published.The strengths of the review include use of a thorough search strategy to identify published and unpublished studies in multiple languages, independent evaluation of individual study quality by 2 authors using the Jadad scale, contact with authors of included trials for missing information, consideration of heterogeneity, and comprehensive discussion of the clinical application of the results. Limitations include the small number of RCTs available for inclusion in the review; differences in the URTIs studied in individual trials and limited information about the extent of illness; and limited information on the context of practice (eg, rural or urban) and practice populations (eg, socioeconomic status and ethnicity). The review by Arroll et al found that delayed prescriptions reduce antibiotic use in patients with URTIs. However, as Arroll ef a/have noted, the use of delayed prescriptions is low risk but not risk free. Although no risks are associated with delayed prescribing for the common cold, some risk is associated with delayed prescribing in some URTIs, such as otitis media and pharyngitis. Before delaying a prescription, practitioners need to carefully assess patients, their home environment, and their confidence to recognise and respond to changes in symptom patterns. Use of delayed prescriptions in more vulnerable populations, such as infants and elderly people with URTIs other than the common cold, needs further investigation before it can be safely recommended. Whether or not delayed prescriptions are used, educating patients about appropriate antibiotic use is an important intervention in the management of URTIs in primary healthcare.