Обзорная статья

Delayed antibiotic prescribing for respiratory tract infections: individual patient data meta-analysis

Beth StuartAcademic Unit of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UKHilda HounkpatinAcademic Unit of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UKTaeko BecqueAcademic Unit of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UKGuiqing YaoBiostatistics Research Group, Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UKShihua ZhuAcademic Unit of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UKPablo Alonso‐CoelloIberoamerican Cochrane Centre, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau-CIBERESP), Barcelona, SpainAttila AltinerInstitute of General Practice, Rostock University Medical Center, Rostock, GermanyBruce ArrollDepartment of General Practice and Primary Health Care, University of Auckland, Auckland, New ZealandDankmar BöhningSouthampton Statistical Sciences Research Institute, University of Southampton, Southampton, UKJennifer BostockDivision of Health and Social Care Research, King's College London, London, UKHeiner C. BucherBasel Institute for Clinical Epidemiology and Biostatistics (CEB), University Hospital Basel and University of Basel, SwitzerlandJennifer ChaoPediatric Emergency Medicine, State University of New York Downstate, Brooklyn, New York, USAMariam de la Poza AbadInstitut Català de la Salut, CAP Doctor Carles Ribas, Foc 112, Barcelona, SpainNick FrancisAcademic Unit of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UKDavid GillespieCentre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UKAlastair D HayCentre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UKTimothy KenealyDepartment of General Practice and Primary Health Care, University of Auckland, Auckland, New ZealandChristin LöfflerInstitute of General Practice, Rostock University Medical Center, Rostock, GermanyDavid P. McCormickDepartment of Pediatrics, University of Texas Medical Branch at Galveston, Galveston, TX, USAGemma Mas‐DalmauInstituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, SpainLaura MuñozAgència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, SpainKirsty SamuelASPIRE PPI Panel, Leeds Institute for Health Sciences, University of Leeds, Leeds, UKMichael MooreAcademic Unit of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UKPaul LittleAcademic Unit of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK

2021en

ABI

Аннотация

OBJECTIVE: 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: 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.

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Идентификаторы

DOI: 10.1136/bmj.n808

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Цитирований: 2Использованных источников: 0

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