Previous reviews indicate that antibiotics have, at best, only modest benefit for acute respiratory tract infections (ARTIs). These benefits need to be balanced against adverse effects, costs, and the risk of bacteria becoming resistant to antibiotics. One way for doctors to reduce the use of antibiotics is to prescribe delayed, (meaning providing the prescription, but advising the patient/carer to delay their use in the hope that symptoms resolve first). Delayed prescribing resulted in 32% of patients using antibiotics compared to 93% of patients in the immediate prescription group. However, not prescribing antibiotics at all results in the least antibiotic prescribing (14% of patients used antibiotics).
While this review found 10 studies looking at prescribing strategies for respiratory infections, it was generally not possible to combine results from different studies because of incomplete information from some studies and the different types of patients in each study. There were only three trials comparing the strategies of delayed and no antibiotics.
For most symptoms like fever, pain and malaise, there was no difference between immediate, delayed and no antibiotics. The only differences were small and favoured immediate antibiotics for relieving pain and fever for sore throat and pain and malaise for middle ear infections. There was little difference in adverse effects of antibiotics for the three prescribing strategies and no significant difference in complication rates.
Patient satisfaction was slightly reduced in the delayed antibiotic group (87% satisfied) compared to the immediate antibiotic group (92% satisfied). Satisfaction rates were similar between delayed and no antibiotic groups (83% satisfied).
When doctors feel it is safe not to prescribe antibiotics immediately, prescribing none with advice to return if symptoms do not resolve rather than delaying them will result in lower subsequent antibiotic use, while maintaining similar patient satisfaction and symptom outcomes.