1. Delayed Antibiotic Prescription for Children With Respiratory Infections: A Randomized Trial
- Author
-
Oscar Espinazo Ramos, Teresa Valls Duran, Gemma Mas-Dalmau, Laura Muñoz Ortiz, Mariam de la Poza Abad, María Encarnación Gonzalo Alonso, Emma Argüelles Prendes, Paul Little, Tatiana Menéndez Bada, María Pilar Cortés Viana, Pedro J Gorrotxategi Gorrotxategi, Pablo Alonso-Coello, Carmen Villanueva López, Marta Esther Vázquez Fernández, and Ana Isabel Pérez Hernández
- Subjects
Male ,Parents ,medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,Adolescent ,Severity of Illness Index ,law.invention ,Time-to-Treatment ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Interquartile range ,030225 pediatrics ,Internal medicine ,Severity of illness ,medicine ,Humans ,Medical prescription ,Sinusitis ,Adverse effect ,Child ,Respiratory Tract Infections ,Respiratory tract infections ,Primary Health Care ,business.industry ,medicine.disease ,Anti-Bacterial Agents ,Nap ,Treatment Outcome ,Patient Satisfaction ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,business - Abstract
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.
- Published
- 2020