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The previous systematic reviews of delayed prescription documented variation between the antibiotic redemption rates for different strategies of delayed prescription, 8 9 10 with higher redemption rates for some studies using the patient led approach.
For these reasons, we designed a multicenter, randomized clinical trial to assess delayed prescription in Spain.
c) Group 3: delayed prescription by handing the prescription to the patient.
Earlier trials assessed placebo compared with antibiotic treatment for urinary tract infection as well as delayed prescription of antibiotics.
In a more recent systematic review Spurling et al showed that delayed prescription significantly reduces antibiotic consumption [ 20].
It shows little difference in symptom control between strategies involving no prescription, immediate prescription, or delayed prescription.
Two thirds of the general practitioners in the intervention arm returned prescription data including results from the delayed prescription pop-up dialogue.
Seventy two patients per group or 450 in total were needed in the groups with no prescription or delayed prescription, allowing for 20% loss to follow-up.
Clinicians will need to rely on strategies such as safety netting or delayed prescription in managing the uncertainty and low risk of complications.
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Therefore, giving the wrong antibiotics may actually do more harm than not giving antibiotics initially and adopting a delayed-prescription strategy.
7 Systematic reviews of delayed prescription where the patient is advised to wait for at least the expected natural history of the illness before using the prescription have concluded that the strategy is an effective way of reducing antibiotic use but could result in poor symptom control.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com