4.7 Article

Delayed Antibiotic Prescription for Children With Respiratory Infections: A Randomized Trial

Journal

PEDIATRICS
Volume 147, Issue 3, Pages -

Publisher

AMER ACAD PEDIATRICS
DOI: 10.1542/peds.2020-1323

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Funding

  1. Instituto de Salud Carlos III under a 2016 grant call (Accion Estrategica en Salud 2013-2016: Programa de Investigacion Orientada a los Retos de la Sociedad) of the Spanish National Plan for Scientific and Technical Research and Innovation 2013-2016 - Euro [PI11/02192]
  2. Spanish Ministry of Health, Social Services, and Equality [EC11-339]

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The study found that there was no statistically significant difference in symptom duration or severity in children with uncomplicated respiratory infections who received delayed antibiotic prescription (DAP) compared to immediate antibiotic prescription (IAP) or no antibiotic prescription (NAP); however, DAP reduced antibiotic use and gastrointestinal adverse effects.
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.

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