The objective of the large population-based study was to examine the safety of a no antibiotic or delayed antibiotic prescribing strategy in patients with URTIs. Such a strategy is currently recommended by NICE except in more severe cases.
The researchers used the English Clinical Practice Research Databank (CPRD) and Welsh Secure Anonymised Information Linkage (SAIL) to identify 1.82 million patients with URTIs and prescriptions of amoxicillin, clarithromycin, doxycycline, erythromycin or phenoxymethylpenicillin on or within 30 days after diagnosis.
The primary outcome of interest was hospital admission for infection-related complications occurring in the 30 days after the antibiotic prescription.
Delayed antibiotic prescribing (identified in 8.3% of the study population) was associated with a 52% increase in the risk of infection-related hospital admission (adjusted hazard ratio [HR] 1.52 [95% CI 1.43-1.62]), with the effects lowest in children (adjusted HR 1.36 [95% CI 1.25-1.47]) and highest in adults aged 18 to 59 years (adjusted HR 1.61 [95% CI 1.42-1.84]).
The study findings showed that delayed prescribing was not targeted to patients with lower risks of complications. They also showed that the probability of delayed antibiotic prescribing was not related to predicted risks of hospital admission.
Further research needed
The researchers state that further research is needed to optimise the targeting of delayed antibiotic prescribing in order to provide more specific guidance on when and when not to use this strategy.