Delayed antibiotic prescription in upper respiratory tract infections: a new trend?

Background Upper respiratory tract infections (URTI) are one of the main reasons for consultation in primary care. Approximately 60% of all antibiotic prescriptions aim at the treatment of URTI, even without a laboratory-based diagnosis. Delayed antibiotic prescription in primary care has shown to reduce antibiotic consumption, without increasing risk of complications, yet is not widely used. Rapid tests to confirm the etiology of URTI are available at pharmacies, but not purchased routinely. In this context, the aim of this study is to assess the knowledge of rapid tests for the diagnosis of URTI, and the awareness of strategies to decrease antibiotic use. Methods A team of experts in the field developed a questionnaire specifically for the purpose of this study. The Pharmacy graduate students of ESTESC-Coimbra Health School (Portugal) answered the questionnaire online. Results Over 90% of the respondents with a URTI stated that the general practitioner prescribed the antibiotic without a lab test. When given the option, 58% are willing to pay up to 50 Euros for a rapid test, yet are not familiar with any brand. Although the respondents aren’t familiarized with the concept, when asked, the majority (87%) are more likely to choose a delayed than an immediate prescription. Conclusions Pharmacy graduates are willing to support the use of delayed prescription, to give time for the lab confirmation of the diagnosis. A broader dissemination of the clinical evidence supporting the use of rapid tests and of delayed prescription is necessary to help managing URTI.

Multicenter, Randomized, Open-Label, Comparative Study of Therapeutic Efficacy, Safety and Tolerability of BNO 1030 application in the technology of delayed prescription of antibiotics in patients with severe acute tonsillitis

Acute bacterial tonsillitis occurs in 20 –30 % of immunocompetent children; however, the frequency of antibacterial drug prescriptions reaches up to 90 %. Delayed antibiotic prescription is recommended by current guidelines. The study objective was to determine the efficacy of phytoneering extract BNO 1030 in the technology of delayed antibiotic prescription in patients with severe acute tonsillitis.MethodsIn the multicenter, randomized, open-label, comparative study, 182 out of 200 randomized children with acute tonsillitis aged 6 –12 years completed the study. Evaluation criteria: a reduced severity of sore throat when swallowing and at rest, throat irritation at rest, hyperemia of the tonsils assessed by a physician according to a 4-point scale at each visit compared to Visit 1, dynamics of self-assessment of general well-being, intensity of sore throat and difficulty swallowing according to a 10-point visual analogue scale, frequency of antibiotic prescriptions, therapeutic benefit from BNO 1030 in days.ResultsThe use of phytotherapeutic medicinal product BNO 1030 in addition to the standard symptomatic treatment of severe acute tonsillitis provides a clinically significant, adequate reduction in the symptom severity assessed by a physician at V2 (p < 0.005). There are significant differences in the patient’s self-assessment of the symptoms from treatment Day 2 (p < 0.005). This allows to significantly reduce the duration of systemic antipyretic administration (p < 0.005). In the first days of treatment, when a decision on delay of antibiotic prescription is made, a therapeutic benefit in two days in patients of the treatment group was observed compared to the control group. The use of BNO 1030 in patients with severe acute tonsillitis significantly reduces, by 43.7 % or 2.3 times, the need for prescribing antibiotic therapy as part of the technology of delayed antibiotic prescription (p < 0.005). During treatment, no side effects and complications of the disease were recorded.ConclusionBNO 1030 is a safe and effective medicinal product for the treatment of severe acute tonsillitis in children aged 6 –12 years. It provides a significant therapeutic benefit when administered in addition to standard symptomatic therapy and reduces the irrational antibiotic prescription.Trial registrationClinicalTrials.gov Identifier: NCT04537819https://clinicaltrials.gov/ct2/show/NCT04537819?term=ATi-2&draw=2&rank=1

Attendere prima di usare l’antibiotico nelle infezioni delle vie respiratorie pediatriche non peggiora la prognosi e riduce il consumo di farmaci non necessari: i risultati di un RCT

Waiting before using the antibiotic in pediatric respiratory tract infections does not worsen the prognosis and reduces the consumption of unnecessary drugs: the results of an RCT The prescription of antibiotics in pediatric age is high and could be reduced as respiratory diseases often do not require pharmacological intervention. This pragmatic study carried out in primary care in Spain compared three intervention arms: delayed antibiotic prescription, immediate or no prescription; the 30-day follow-up revealed no differences in the duration of the disease or in the severity of symptoms in the three groups of children. Despite the good methodological quality, the RCT could be affected by a significant selection bias; nevertheless, several other studies on the subject lead to similar results.

Delayed Antibiotic Prescription by General Practitioners in the UK: A Stated-Choice Study

Delayed antibiotic prescription in primary care has been shown to reduce antibiotic consumption, without increasing risk of complications, yet is not widely used in the UK. We sought to quantify the relative importance of factors affecting the decision to give a delayed prescription, using a stated-choice survey among UK general practitioners. Respondents were asked whether they would provide a delayed or immediate prescription in fifteen hypothetical consultations, described by eight attributes. They were also asked if they would prefer not to prescribe antibiotics. The most important determinants of choice between immediate and delayed prescription were symptoms, duration of illness, and the presence of multiple comorbidities. Respondents were more likely to choose a delayed prescription if the patient preferred not to have antibiotics, but consultation length had little effect. When given the option, respondents chose not to prescribe antibiotics in 51% of cases, with delayed prescription chosen in 21%. Clinical features remained important. Patient preference did not affect the decision to give no antibiotics. We suggest that broader dissemination of the clinical evidence supporting use of delayed prescription for specific presentations may help increase appropriate use. Establishing patient preferences regarding antibiotics may help to overcome concerns about patient acceptance. Increasing consultation length appears unlikely to affect the use of delayed prescription.