Delayed Antibiotic Prescription for Children With Respiratory Infections: A Randomized Trial
Por:
Mas-Dalmau, G, Lopez, CV, Gorrotxategi, PG, Prendes, EA, Ramos, OE, Duran, TV, Alonso, MEG, Viana, MPC, Bada, TM, Fernandez, MEV, Hernandez, AIP, Ortiz, LM, Little, P, Abad, MD, Alonso-Coello, P, DAP Pediat Grp
Publicada:
1 mar 2021
Resumen:
OBJECTIVES: To assess the effectiveness and safety of delayed antibiotic prescription (DAP) compared to immediate antibiotic prescription (IAP) and no antibiotic prescription (NAP) in children with uncomplicated respiratory infections.
METHODS: Randomized clinical trial comparing 3 antibiotic prescription strategies. The participants were children with acute uncomplicated respiratory infections attended to in 39 primary care centers. Children were randomly assigned into prescription arms as follows: (1) DAP, (2) IAP, or (3) NAP. Primary outcomes were symptom duration and severity. Secondary outcomes were antibiotic use, parental satisfaction, parental beliefs, additional primary care visits, and complications at 30 days.
RESULTS: In total, 436 children were included in the analysis. The mean (SD) duration of severe symptoms was 10.1 (6.3) for IAP, 10.9 (8.5) for NAP, and 12.4 (8.4) for DAP (P = .539), although the differences were not statistically significant. The median (interquartile range) of the greatest severity for any symptom was similar for the 3 arms (median [interquartile range] score of 3 [2-4]; P = .619). Antibiotic use was significantly higher for IAP (n = 142 [96%]) compared to DAP (n = 37 [25.3%]) and NAP (n = 17 [12.0%]) (P < .001). Complications, additional visits to primary care, and satisfaction were similar for all strategies. Gastrointestinal adverse effects were higher for IAP.
CONCLUSIONS: There was no statistically significant difference in symptom duration or severity in children with uncomplicated respiratory infections who received DAP compared to NAP or IAP strategies; however, DAP reduced antibiotic use and gastrointestinal adverse effects.
Filiaciones:
Mas-Dalmau, G:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, St Antoni Maria Claret 167, Barcelona 08025, Spain
Biomed Res Inst St Pau IIB St Pau, Nursing Care Reserch Grp, Barcelona, Spain
Lopez, CV:
Manso Primary Care Ctr, Barcelona, Spain
Gorrotxategi, PG:
Pasai San Pedro Primary Care Ctr, Pasaia, Spain
Prendes, EA:
Ribadesella Primary Care Ctr, Ribadesella, Spain
Ramos, OE:
Las Matas Primary Care Ctr, Las Rozas De Madrid, Spain
Duran, TV:
Val Minor Primary Care Ctr, Nigran, Spain
Alonso, MEG:
Ugao Miraballes Primary Care Ctr, Ugao Miraballes, Spain
Arrigorriaga Primary Care Ctr, Arrigorriaga, Spain
Viana, MPC:
Maragall Primary Care Ctr, Barcelona, Spain
Bada, TM:
Iruna Oka Primary Care Ctr, Nanclares De Oka, Spain
Fernandez, MEV:
Arturo Eyries Primary Care Ctr, Valladolid, Spain
Hernandez, AIP:
Torrelodones Primary Care Ctr, Torrelodones, Spain
Ortiz, LM:
Agcy Hlth Qual & Assessment Catalonia, Barcelona, Spain
Little, P:
Aldermoor Hlth Ctr, Southampton, Hants, England
Abad, MD:
Dr Carles Ribas Primary Care Ctr, Barcelona, Spain
Alonso-Coello, P:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, St Antoni Maria Claret 167, Barcelona 08025, Spain
CIBER Epidemiol & Publ Hlth CIBERESP, Madrid, Spain
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