Delayed prescription strategies consist of prescribing an antibiotic to take only if the symptoms worsen or if there is no improvement several days after the medical visit; this method is known to decrease antibiotic use with reasonable symptom control. A study published in JAMA Internal Medicine examined the safety and efficacy of various prescription strategies in the treatment of acute uncomplicated respiratory infections.

Mariam de la Poza Abad, MD, from Doctor Carles Ribas Primary Care Center, in Barcelona, Spain, and colleagues conducted a pragmatic, open-label, 4-arm randomized clinical trial enrolling 405 adults with acute, uncomplicated respiratory infections across 23 primary care centers. Study patients were randomized to one of the following prescription strategies:

  • a delayed patient-led prescription strategy (given antibiotic at first consultation)
  • a delayed prescription collection strategy (requiring patients to collect their prescription from the primary care center 3 days after first consultation)
  • an immediate prescription strategy (received antibiotic at first visit and instructed to start drug on the same day)
  • no antibiotic strategy

The primary outcomes were duration of symptoms and severity of symptoms. Symptoms were scored using the 6-point Likert scale (moderate: 3–4; severe: 5–6). Secondary outcomes were antibiotic use, patient satisfaction, and patients’ beliefs in the efficacy of antibiotics. 

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The presence of symptoms on the first visit was similar among the 4 study arms.  The mean duration of severe symptoms was 3.6 days for the immediate prescription group and 4.7 days for the no prescription group. The median duration of severe symptoms was 3 days for the prescription collection group and 3 days for the patient-led prescription group. The median of the maximum severity for any symptom was 5 for the immediate prescription and the prescription collection group; 5 for the patient-led prescription group; and 5 for the no prescription group. 

Patients in the no prescription strategy or any of the delayed strategies used less antibiotics and less frequently believed in antibiotic efficacy. Researchers noted that satisfaction was similar among the study arms.

Overall, strategies for delayed prescription use led to slightly greater but clinically similar symptom burden and duration as well as significantly decreased antibiotic use versus an immediate strategy. In a separate JAMA Internal Medicine commentary, Amanda R. McCullough, PhD, noted “Delayed prescribing is not perfect. It is a compromise between an immediate prescription and a no prescription strategy. Some patients will still receive antibiotics they do not need, but the evidence shows that delayed prescribing strategies substantially reduce antibiotic use, so we should embrace them as a simple step we can take toward reducing antibiotic resistance caused by antibiotic use in acute respiratory infections. “

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