Use of delayed antibiotic prescription in primary care: a cross-sectional study

Abstract

BackgroundOne of several strategies developed to reduce inappropriate antibiotic use in situations where the indication is not clear is delayed antibiotic prescription (DAP), defined as an antibiotic prescription issued for the patient to take only in case of feeling worse or not feeling better several days after the visit. We conducted a survey to identify DAP use in Spanish primary care settings.MethodsWe surveyed 23 healthcare centers located in 4 autonomous regions where a randomized controlled trial (RCT) on DAP was underway. The primary variable was use of DAP. Categorical and quantitative variables were analyzed by means of the chi-squared test and non-parametric tests, respectively.ResultsThe survey was sent to 375 healthcare professionals, 215 of whom responded (57.3% response rate), with 46% of these respondents declaring that they had used DAP in routine practice before the RCT started (66.6% afterwards), mostly (91.5%) for respiratory tract infections (RTIs), followed by urinary infections (45.1%). Regarding DAP use for RTIs, the most frequent conditions were pharyngotonsillitis (88.7%), acute bronchitis (62.7%), mild chronic obstructive pulmonary disease exacerbations (59.9%), sinusitis (51.4%), and acute otitis media (45.1%). Most respondents considered that DAP reduced emergency visits (85.4%), scheduled visits (79%) and inappropriate antibiotic use (73.7%) and most also perceived patients to be generally satisfied with the DAP approach (75.6%). Having participated or not in the DAP RCT (74.1% versus 46.2%; p < 0.001), having previously used or not used DAP (86.8% versus 44.2%; p < 0.001), and being a physician versus being a nurse (81.8% versus 18.2%; p < 0.001) were factors that reflected significantly higher rates of DAP use.ConclusionsThe majority of primary healthcare professionals in Spain do not use DAP. Those who use DAP believe that it reduces primary care visits and inappropriate antibiotic use, while maintaining patient satisfaction. Given the limited use of DAP in our setting, and given that its use is mainly limited to RTIs, DAP has considerable potential in terms of its implementation in routine practice.Electronic supplementary materialThe online version of this article (10.1186/s12875-019-0934-7) contains supplementary material, which is available to authorized users.

Delayed Antibiotic Prescription by General Practitioners in the UK: A Stated-Choice Study

“…Two attributes shared with our study (patient preferences and duration of illness) had significant effects in both studies; the effect of patient preferences was less in our study, possibly because of the strong effect of symptoms in our study, which were held constant in the Australian work [26]. Our findings are consistent with qualitative observations on the importance of perceived patient expectations in different countries [19,[24][25][26]43,44]. These similarities suggest our results may be generalisable to other settings with similar primary healthcare systems.…”

Prescribers’ Knowledge, Attitudes and Behaviors on Antibiotics, Antibiotic Use and Antibiotic Resistance in Jordan

“…It is known that delaying antibiotic prescribing can control inappropriate antibiotic use without affecting the health outcomes for patients [46,47]; however, many practitioners in this study did not use this strategy. According to De la Poza Abad and colleagues, 46% of physicians in Spanish primary care settings were found to use this strategy, especially when treating respiratory tract infections [48]. However, our findings indicate that higher percentages of prescribers have used this strategy of delayed prescribing (34.3%) compared to those reported in Germany (29.4%) [27].…”

Risk factors for treatment failure in women with uncomplicated lower urinary tract infection

“…With their widespread use, there is increasing resistance to fosfomycin and nitrofurantoin [ 2 ], the two antibiotics currently recommended as first-line therapy [ 1 ]. At the same time, delayed antibiotic treatment strategies [ 3 ] are being increasingly used for this mucosal infection given its sizeable rate of spontaneous remission [ 4 , 5 ], the low risk of progression to pyelonephritis [ 1 ], and clear evidence that frequent antimicrobial therapy increases the risk of acquiring multi-resistant organisms [ 6 , 7 ]. As resistance to first-line agents increases and delayed-therapy approaches become more popular, there is a growing need to identify appropriate candidates by identifying risk factors for clinical failure or non-recovery.…”