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The quick fix that dramatically cuts antibiotic use

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Simply asking patients to wait a couple of days to see if their symptoms resolve before filling their script substantially cuts antibiotic use, an Australian meta-analysis has found.

The Cochrane review, led by the University of Queensland’s Primary Care Clinical Unit, looked at 11 studies involving 3,500 patients with suspected common respiratory tract infections. It essentially found no significant clinical difference in outcomes between patients randomised to immediate prescription of antibiotics, delayed prescription, or no prescription.

There were also very low rates of complications or missed treatment of serious complications in those randomised to the ‘wait-and-see’ prescriptions.

But delaying prescription led to a massive drop in antibiotic use. Over 90% of patients with an immediate prescription filled it, compared with around 30% of those with a delayed prescription.

Patients were more satisfied with being given a delayed prescription compared with being given no prescription at all – a significant finding since it’s well recognised that some of the pressure to prescribe antibiotics comes from the patients themselves.

The studies reviewed involved acute respiratory tract infections, including cough, sore throat, colds and otitis media.

Lead author Dr Geoffrey Spurling said the review showed delayed prescribing could be an acceptable compromise if a doctor didn’t believe antibiotics were needed at the time of the consult, but was uneasy about adopting a ‘no-antibiotics’ approach.

“The evidence indicates that delayed prescribing is an effective strategy for reducing antibiotic use and now we need to get this message out the medical community,” he said. “Individual GPs can feel confident implementing this strategy for reducing antibiotic use as a way of treating infections if they are uncomfortable with not prescribing antibiotics.”

As outlined in research recently published in the MJA, Australia has a very high rate of prescribing antibiotics for respiratory tract infections, with antibiotics prescribed at 4-9 times more often than is recommended by therapeutic guidelines.

Australia’s Chief Medical Officer recently sent written warnings to the top 30% of antibiotic prescribers, asking them to think about what they can do to reduce their prescribing.

You can access the Cochrane Review here.

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