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Delayed antibiotic prescription for children with respiratory infections: A randomized trial

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.

0031-4005
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
bdf25a4e-90b1-4442-bbf3-0e943ca783a7
Alonso-Coello, Pablo
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Mas-Dalmau, Gemma
86902702-1211-4313-bf1f-1273659ee89b
Villanueva López, Carmen
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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
5da914ad-9135-47e7-aec9-a6d29e1cba88
Menéndez Bada, Tatiana
4be91831-ea20-4f9f-9b3c-b7c6895f7251
Vázquez Fernández, Marta Esther
bee7de77-8c75-4530-8a02-a1300564f39b
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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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).

Record type: Article

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: March 2021

Identifiers

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 Dec 2021 12:17

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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: Paul Little
Author: Mariam De La Poza Abad
Author: Pablo Alonso-Coello

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