Delayed antibiotic prescribing for respiratory tract infections: individual patient data meta-analysis
Por:
Stuart, B, Hounkpatin, H, Becque, T, Yao, GQ, Zhu, SH, Alonso-Coello, P, Altiner, A, Arroll, B, Bohning, D, Bostock, J, Bucher, HC, Chao, J, de la Poza, M, Francis, N, Gillespie, D, Hay, AD, Kenealy, T, Loffler, C, McCormick, DP, Mas-Dalmau, G, Munoz, L, Samuel, K, Moore, M, Little, P
Publicada:
28 abr 2021
Resumen:
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 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.
Filiaciones:
Stuart, B:
Univ Southampton, Acad Unit Primary Care Populat Sci & Med Educ, Fac Med, Southampton SO16 5ST, Hants, England
Hounkpatin, H:
Univ Southampton, Acad Unit Primary Care Populat Sci & Med Educ, Fac Med, Southampton SO16 5ST, Hants, England
Becque, T:
Univ Southampton, Acad Unit Primary Care Populat Sci & Med Educ, Fac Med, Southampton SO16 5ST, Hants, England
Yao, GQ:
Univ Leicester, Coll Life Sci, Dept Hlth Sci, Biostat Res Grp, Leicester, Leics, England
Zhu, SH:
Univ Southampton, Acad Unit Primary Care Populat Sci & Med Educ, Fac Med, Southampton SO16 5ST, Hants, England
Alonso-Coello, P:
Inst Invest Biomed St Pau IIB St Pau CIBERESP, Iberoamer Cochrane Ctr, Barcelona, Spain
Altiner, A:
Rostock Univ, Inst Gen Practice, Med Ctr, Rostock, Germany
Arroll, B:
Univ Auckland, Dept Gen Practice & Primary Hlth Care, Auckland, New Zealand
Bohning, D:
Univ Southampton, Southampton Stat Sci Res Inst, Southampton, Hants, England
Bostock, J:
Kings Coll London, Div Hlth & Social Care Res, London, England
Bucher, HC:
Univ Hosp Basel, Basel Inst Clin Epidemiol & Biostat CEB, Basel, Switzerland
Univ Basel, Basel, Switzerland
Chao, J:
SUNY Downstate, Pediat Emergency Med, Brooklyn, NY USA
de la Poza, M:
Inst Catala Salut, Cap Doctor Carles Ribas, Foc 112, Barcelona, Spain
Francis, N:
Univ Southampton, Acad Unit Primary Care Populat Sci & Med Educ, Fac Med, Southampton SO16 5ST, Hants, England
Gillespie, D:
Cardiff Univ, Coll Biomed & Life Sci, Ctr Trials Res, Sch Med, Cardiff, Wales
Hay, AD:
Univ Bristol, Ctr Acad Primary Care Populat Hlth Sci Bristol, Bristol Med Sch, Bristol, Avon, England
Kenealy, T:
Univ Auckland, Dept Gen Practice & Primary Hlth Care, Auckland, New Zealand
Loffler, C:
Rostock Univ, Inst Gen Practice, Med Ctr, Rostock, Germany
McCormick, DP:
Univ Texas Med Branch, Dept Pediat, Galveston, TX 77555 USA
Mas-Dalmau, G:
Inst Invest Biomed St Pau IIB St Pau, Barcelona, Spain
Munoz, L:
Agencia Qualitat & Avaluacio Sanitaries Catalunya, Barcelona, Spain
Samuel, K:
Univ Leeds, Leeds Inst Hlth Sci, Aspire PPI Panel, Leeds, W Yorkshire, England
Moore, M:
Univ Southampton, Acad Unit Primary Care Populat Sci & Med Educ, Fac Med, Southampton SO16 5ST, Hants, England
Little, P:
Univ Southampton, Acad Unit Primary Care Populat Sci & Med Educ, Fac Med, Southampton SO16 5ST, Hants, England
Green Accepted, Green Published, hybrid
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