Intended for healthcare professionals


Delayed prescriptions

BMJ 2003; 327 doi: (Published 11 December 2003) Cite this as: BMJ 2003;327:1361
  1. Bruce Arroll, associate professor (,
  2. Tim Kenealy, doctoral fellow,
  3. Felicity Goodyear-Smith, senior lecturer,
  4. Ngaire Kerse, senior lecturer
  1. Department of General Practice and Primary Health Care Faculty of Medical and Health Sciences University of Auckland PB 92019 Auckland New Zealand

    Can reduce antibiotic use in acute respiratory infections

    Although a reduction has occurred in the use of antibiotics for upper respiratory tract infections, international evidence indicates that they continue to be used for these conditions.1 This is in spite of Cochrane reviews indicating minimal or no benefit from antibiotics for sore throat, acute bronchitis, the common cold, and otitis media. This situation of potentially inappropriate prescribing prompted one commentator to suggest the use of delayed prescriptions (also known as “back-pocket,” “back-up,” or “as needed” prescriptions).2 These are prescriptions written with a proviso that they not be used immediately and only if symptoms do not improve.

    The first randomised trial of delayed prescriptions for respiratory symptoms was undertaken by Little et al (1997), who gave antibiotics, with the prescription to be filled immediately or after three days, or no antibiotics for acute sore throat.3 The immediate group filled 99% of the antibiotic prescriptions whereas …

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