BACKGROUND: With increasing concern about the development of antibacterial resistance, a reduction in the use of antibiotics is a challenge that must be solved. Different strategies to reduce the use of antibiotics has been investigated, and one of these is delayed prescription.
This review evaluated the effect of delayed prescription for patients with respiratory tract infection.
METHODS: MEDLINE (Ovid), EMBASE and Cochrane Central Register of Controlled Trials was searched from January 1980 to February 2009.
Randomized controlled trials with an intervention between delayed antibiotics, no antibiotics and immediate antibiotics for patients of all ages with respiratory tract infection were included. The effect of these strategies was evaluated on the basis of reduction of antibiotic consumption, differences in clinical outcome and patient satisfaction.
MAIN RESULTS: Delayed prescription reduced the use of antibiotic treatment with 52% - 72%. All the patients were satisfied with the consultation, but the group who received the immediate prescription were the most satisfied.
The difference in clinical outcomes between the groups was small, but significant in two of the studies where it was reported more pain in the intervention group. These studies included patients with acute otitis media. The control group had 1.1 days shorter illness and less use of paracetamol, but more diarrhoea.
CONCLUSION: Delayed prescription seems like an effective strategy to reduce the use of antibiotics for respiratory tract infections, but it must be determined in advance which patients are suitable for this type of treatment to avoid serious complications.