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Evidence summaries

Delayed Antibiotics for Respiratory Infections

There were no differences between immediate, delayed, and no antibiotics for many symptoms including fever, pain, feeling unwell, cough, and runny nose. Compared to no antibiotics, delayed antibiotics led to a small reduction in the duration of pain, fever, and cough in people with colds. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 11 studies with a total of 3 555 subjects. Heterogeneity of the included studies and their results generally precluded meta-analysis with patient satisfaction being an exception. None of the included studies evaluated antibiotic (AB) resistance. Nine studies compared immediate with delayed AB; 4 of these trials investigated acute pharyngitis/sore throat, 3 acute otitis media (AOM), 2 cough and one dealt with the common cold. Five studies involved only children, 2 only adults, and 4 included both adults and children.

Patients with cough (3 studies): There were no differences among delayed, immediate, and no prescribed AB for clinical outcomes.

Patients with fever and sore throat (5 studies): Three studies favoured immediate AB, and 2 found no difference. For the outcome of pain related to sore throat, 2 studies favoured immediate AB, and 3 found no difference. One study compared delayed AB with no AB for sore throat, and found no difference in clinical outcomes.

Patients with AOM (3 studies): Of the 2 studies with an immediate AB arm, one study found no difference for fever, and the other study favoured immediate AB for pain and malaise severity on Day 3. One study including participants with AOM compared delayed AB with no AB and found no difference for pain and fever on Day 3.

Patients with common cold (2 studies): Neither study found differences for clinical outcomes between delayed and immediate AB groups. One study favoured delayed AB over no AB for pain, fever, and cough duration.There were either no differences for adverse effects or results favoured delayed AB over immediate AB with no significant differences in complication rates.Delayed AB resulted in a significant reduction in AB use compared to immediate AB prescription (OR 0.04, 95% CI 0.03 to 0.05). However, a delayed AB was more likely to result in reported AB use than no AB (OR 2.55, 95% CI 1.59 to 4.08).Patient satisfaction favoured delayed over no AB (OR 1.49, 95% CI 1.08 to 2.06). There was no significant difference in patient satisfaction between delayed AB and immediate AB (OR 0.65, 95% CI 0.39 to 1.10).

References

  • Spurling GK, Del Mar CB, Dooley L et al. Delayed antibiotic prescriptions for respiratory infections. Cochrane Database Syst Rev 2017;(9):CD004417. [PubMed]

Primary/Secondary Keywords