Gemma Mas-Dalmau1,2, Carmen Villanueva López3, Pedro Gorrotxategi Gorrotxategi4, Emma Argüelles Prendes5, Oscar Espinazo Ramos6, Teresa Valls Duran7, María Encarnación Gonzalo Alonso8,9, María Pilar Cortés Viana10, Tatiana Menéndez Bada11, Marta Esther Vázquez Fernández12, Ana Isabel Pérez Hernández13, Laura Muñoz Ortiz14, Paul Little15, Mariam de la Poza Abad16, Pablo Alonso-Coello17,18. 1. Iberoamerican Cochrane Center, and. 2. Nursing Care Reserch Group, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain. 3. Manso Primary Care Center, Barcelona, Spain. 4. Pasai San Pedro Primary Care Center, Pasaia, Spain. 5. Ribadesella Primary Care Center, Ribadesella, Spain. 6. Las Matas Primary Care Center, Las Rozas de Madrid, Spain. 7. Val Miñor Primary Care Center, Nigrán, Spain. 8. Ugao-Miraballes Primary Care Center, Ugao-Miraballes, Spain. 9. Arrigorriaga Primary Care Center, Arrigorriaga, Spain. 10. Maragall Primary Care Center, Barcelona, Spain. 11. Iruña de Oka Primary Care Center, Nanclares de Oka, Spain. 12. Arturo Eyries Primary Care Center, Valladolid, Spain. 13. Torrelodones Primary Care Center, Torrelodones, Spain. 14. Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain. 15. Aldermoor Health Centre, Southampton, United Kingdom. 16. Dr Carles Ribas Primary Care Center, Barcelona, Spain; and. 17. Iberoamerican Cochrane Center, and palonso@santpau.cat. 18. CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.
Abstract
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.
RCT Entities:
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.
Authors: Samantha S Moe; Betsy Thomas; Michael R Kolber; Christina S Korownyk; Adrienne J Lindblad; Nicolas Dugré; Ricky D Turgeon; Emélie Braschi; G Michael Allan Journal: Can Fam Physician Date: 2022-05 Impact factor: 3.025
Authors: Beth Stuart; Hilda Hounkpatin; Taeko Becque; Guiqing Yao; Shihua Zhu; Pablo Alonso-Coello; Attila Altiner; Bruce Arroll; Dankmar Böhning; Jennifer Bostock; Heiner C Bucher; Jennifer Chao; Mariam de la Poza; Nick Francis; David Gillespie; Alastair D Hay; Timothy Kenealy; Christin Löffler; David P McCormick; Gemma Mas-Dalmau; Laura Muñoz; Kirsty Samuel; Michael Moore; Paul Little Journal: BMJ Date: 2021-04-28