POEMs

Delayed Prescription for Respiratory Infections Produces Similar Results and Satisfaction as Immediate Treatment

 

Am Fam Physician. 2016 May 1;93(9):789-790.

Clinical Question

In patients with respiratory tract infections (bronchitis, sinusitis, pharyngitis), is a delayed prescription strategy as effective as immediate treatment and as accepted by patients?

Bottom Line

In almost 400 Spanish primary care patients with mild to moderate symptoms of respiratory infection of less than one week's duration, both a “take-and-hold” prescription and a “come back and pick up, if necessary” prescription produced a similar clinical response—and similar patient satisfaction score—as immediate antibiotic treatment, while decreasing overall antibiotic use. Other studies of this patient population have shown that patients prefer the security of a prescription, delayed or not, over withholding antibiotic treatment. The effect of legitimizing an illness by awarding a prescription should not be underestimated. (Level of Evidence = 1b)

Synopsis

These researchers evaluated 398 adults with acute, uncomplicated respiratory infections from 23 primary care centers in Spain. The patients had acute pharyngitis (46%), acute bronchitis (32%), rhinosinusitis (20%), or exacerbation of mild to moderate chronic obstructive pulmonary disease (2%). The physicians had “reasonable doubt as to whether to treat with an antibiotic.” Patients were, on average, on the younger side (mid-40s), one-half were smokers or former smokers, almost no patients (less than 2%) were febrile, and they reported mild to moderate symptoms for an average of six days. Patients were randomized, using concealed allocation, to one of four potential prescription strategies. One group was given an antibiotic to begin at once; two groups were given a delayed prescription, either a “take and hold” prescription or a “come back and pick up, if necessary” prescription; and the final group was not given any prescription. The average duration of symptoms was significantly longer in patients not given a prescription compared with patients given an immediate antibiotic,

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP,search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.

 

 

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP


Editor's Collections


Related Content


More in Pubmed

MOST RECENT ISSUE


May 15, 2017

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article