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 …