Delayed prescribing of antibiotics for upper respiratory tract infection

BMJ 2005; 331 doi: http://dx.doi.org/10.1136/bmj.331.7512.301 (Published 4 August 2005)
Cite this as: BMJ 2005;331:301

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  1. Paul Little, professor of primary care research (psl3@soton.ac.uk)
  1. Primary Medical Care, Community Clinical Sciences Division, Southampton University, Aldermoor Health Centre, Southampton SO16 5ST

    With clear guidance to patients and parents it seems to be safe

    The use of antibiotics by children with upper respiratory tract infection halved in the last decade in the United Kingdom, according to a paper in this week's BMJ (p 328).1 Sharland and colleagues attribute this decline to an initially sharp reduction in prescribing by general practitioners and, since 1997, to a reduction in the proportion of prescriptions taken by parents to a pharmacist. Widespread adoption of delayed prescribing, a strategy tested in a randomised controlled trial published in 1997, may well explain this pattern.1 2

    Whether patients fill prescriptions depends, however, on the method of delayed prescribing. Retrospective data and historical comparisons—albeit limited scientifically—suggest that giving a prescription and asking the patient or parent to redeem it only if symptoms persist is more likely to result in antibiotic use than is asking the patient to return to the doctor for a prescription. This is the policy we used in our trials and, when patients were given clear guidance and were asked to return to collect prescriptions, only a few ended up taking antibiotics.2 3

    Should doctors completely avoid prescribing antibiotics for patients with uncomplicated upper respiratory tract infections? The answer is no. Firstly, we do not yet know who is …

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