Delayed antibiotic prescription for children with respiratory infections: A randomized trial
Delayed antibiotic prescription for children with respiratory infections: A randomized trial
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.
Mas-Dalmau, Gemma
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Villanueva López, Carmen
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Gorrotxategi Gorrotxategi, Pedro
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Argüelles Prendes, Emma
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Espinazo Ramos, Oscar
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Valls Duran, Teresa
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Gonzalo Alonso, María Encarnación
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Cortés Viana, María Pilar
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Menéndez Bada, Tatiana
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Vázquez Fernández, Marta Esther
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Pérez Hernández, Ana Isabel
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Muñoz Ortiz, Laura
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Little, Paul
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De La Poza Abad, Mariam
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Alonso-Coello, Pablo
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1 March 2021
Mas-Dalmau, Gemma
86902702-1211-4313-bf1f-1273659ee89b
Villanueva López, Carmen
a6888b5e-5652-49a0-87bd-7f4614ac39c3
Gorrotxategi Gorrotxategi, Pedro
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Argüelles Prendes, Emma
c14e473f-e873-4116-9842-43738725ef1e
Espinazo Ramos, Oscar
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Valls Duran, Teresa
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Gonzalo Alonso, María Encarnación
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Cortés Viana, María Pilar
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Menéndez Bada, Tatiana
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Vázquez Fernández, Marta Esther
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Pérez Hernández, Ana Isabel
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Muñoz Ortiz, Laura
57f0b6c9-823b-4e9d-baf0-0b0c768aa30b
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
De La Poza Abad, Mariam
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Alonso-Coello, Pablo
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Mas-Dalmau, Gemma, Villanueva López, Carmen, Gorrotxategi Gorrotxategi, Pedro, Argüelles Prendes, Emma, Espinazo Ramos, Oscar, Valls Duran, Teresa, Gonzalo Alonso, María Encarnación, Cortés Viana, María Pilar, Menéndez Bada, Tatiana, Vázquez Fernández, Marta Esther, Pérez Hernández, Ana Isabel, Muñoz Ortiz, Laura, Little, Paul, De La Poza Abad, Mariam and Alonso-Coello, Pablo
(2021)
Delayed antibiotic prescription for children with respiratory infections: A randomized trial.
Pediatrics, 147 (3), [e20201323].
(doi:10.1542/peds.2020-1323).
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.
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Accepted/In Press date: 18 November 2020
e-pub ahead of print date: 11 February 2021
Published date: 1 March 2021
Additional Information:
Funding Information:
FUNDING: Funded by Instituto de Salud Carlos III under a 2016 grant call (Acción Estratégica en Salud 2013–2016: Programa de Investigación Orientada a los Retos de la Sociedad) within the framework of the Spanish National Plan for Scientific and Technical Research and Innovation 2013–2016 (dossier PI11/02192) cofunded by the European Union through the European Regional Development Fund and with the support of the Spanish Ministry of Health, Social Services, and Equality (reference EC11-339).
Publisher Copyright:
Copyright © 2021 by the American Academy of Pediatrics
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Local EPrints ID: 447144
URI: http://eprints.soton.ac.uk/id/eprint/447144
ISSN: 0031-4005
PURE UUID: 8d0dde5e-771b-4550-b798-db92681b064b
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Date deposited: 04 Mar 2021 17:38
Last modified: 12 Jul 2024 01:35
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Contributors
Author:
Gemma Mas-Dalmau
Author:
Carmen Villanueva López
Author:
Pedro Gorrotxategi Gorrotxategi
Author:
Emma Argüelles Prendes
Author:
Oscar Espinazo Ramos
Author:
Teresa Valls Duran
Author:
María Encarnación Gonzalo Alonso
Author:
María Pilar Cortés Viana
Author:
Tatiana Menéndez Bada
Author:
Marta Esther Vázquez Fernández
Author:
Ana Isabel Pérez Hernández
Author:
Laura Muñoz Ortiz
Author:
Mariam De La Poza Abad
Author:
Pablo Alonso-Coello
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