Spanish researchers conducted a study aimed at understanding the effects of delaying prescription medication in children with respiratory infections.
The study included 436 children aged 2-14 from 39 primary care centers, most of whom were 10 years old or younger, diagnosed with pharyngitis, rhinosinusitis, acute bronchitis, or acute otitis media. Children with pharyngitis who had access to a streptococcal rapid test were not included.
Participants were divided into three groups randomly:
- No antibiotic treatment offered.
- Antibiotics prescribed with a recommendation to start treatment immediately.
- Antibiotics prescribed but recommended to take only if the patient had a fever or felt significantly worse after 24 hours, or if symptoms did not improve within a certain period (4 days for acute otitis media, 7 days for pharyngitis, 15 days for rhinosinusitis, 20 days for acute bronchitis).
All parents were informed that it was normal for their child to feel worse in the first few days after the doctor’s visit and were explained the natural course of the respective illness.
In the immediate antibiotic treatment group, 96% of children received antibiotics; in the group where antibiotics were recommended only if symptoms worsened, 25% received antibiotics; and in the group where antibiotics were not recommended or prescribed, only 12% of children ultimately received antibiotics.
Regardless of the treatment group, symptom resolution took an average of 8 days. The duration of more severe symptoms was similar in both treatment groups. Treating children’s symptoms with medications other than antibiotics was more common in groups where antibiotics were not offered or delayed. The number of complications and additional doctor visits was similar across groups. The proportion of gastrointestinal symptoms was higher in the group prescribed antibiotics. Satisfaction with treatment was similar across all groups.
In summary, educating parents about the natural course of the illness and what to expect, combined with delaying antibiotic administration, resulted in only one in four children receiving antibiotic treatment. However, there was an increase in the proportion of children receiving alternative medications for symptom control, indicating parents’ desire to do something to help their children feel better. Severity of symptoms, time to resolution, complications, and the need for additional doctor visits were similar regardless of whether immediate, delayed, or no antibiotic treatment was offered. Immediate antibiotic treatment was associated with more gastrointestinal issues. Similar results have been shown in studies involving adults.
This text is a summary of the study “Delayed antibiotic prescription for children with respiratory infections: a randomized trial”, authored by Mas-Dalmau G, Villanueva López C, Gorrotxategi Gorrotxategi P, et al.
For more information about the study, please refer to: https://pubmed.ncbi.nlm.nih.gov/33574163/
