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Delayed Antibiotic Prescription for Children With Respiratory Infections: A Randomized Trial
- Source :
- Pediatrics. 147(3)
- Publication Year :
- 2020
-
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.
- 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
Subjects
Details
- ISSN :
- 10984275
- Volume :
- 147
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Pediatrics
- Accession number :
- edsair.doi.dedup.....f331f640338f061c2344cdaad70c7b68