Delaying antibiotic prescribing

Delaying antibiotic prescribing

Current situation  

The DoH is trying to reduce antibiotic prescribing in general practice to children with URTIs to minimise antibiotic resistance.  

GPs are also encouraged not to give antibiotics immedi-ately to children with middle ear infections.  

What is the evidence?  

Advantages of delaying prescribing include reduced overall antibiotic use, changed consultation patterns, avoiding medicalisation of minor illness and adequate control of symptoms (BMJ 2005; 331: 301).  

National data on commun-ity prescribing of antibiotics and hospital admissions for peritonsillar abscess, mastoiditis, and rheumatic fever in children between 1993 and 2003 has been examined (BMJ 2005; 331: 328).  

A fall of 50 per cent in antibiotic prescribing to children was not found to be accompanied by any increase in hospital admissions for peritonsillar abscess or rheumatic fever.       

However, the results of a randomised, double-blind placebo-controlled trial of amoxicillin for acute otitis media in young children do not support the hypothesis that the cure rate among those receiving placebo is similar to that among those who take active treatment (Can Med Assoc J 2005; 172: 335).  

Children who received placebo had more pain and fever in the first two days. But, delaying treatment with antibiotics was associated with resolution of symptoms in most children.  

A UK study showed that delaying antibiotics for acute otitis media in children did not significantly increase repeat episodes of earache (Br J Gen Pract 2006; 56: 176)  

A recent meta-analysis has shown that for most children with otitis media, observation without using antibiotics is safe (Lancet 2006; 368: 1,429).  

Children under two years of age with bilateral otitis media and those with otitis media with otorrhoea had the greatest benefit from taking antibiotics.  

Implications for practice  

One study showed that antibiotics provided little or no benefit for patients (whether adults or children) with cough and lower respiratory symptoms, including fever and green sputum (JAMA 2005; 293: 3,029).   

Surprisingly, providing an educational leaflet had no effect on outcomes. Providing a verbal explanation of the expected course of the infection and potential complications of a cough was most likely to assure optimal patient satisfaction.  

Available guidelines  

DoH Standing Medical Advisory Committee Sub-group on Antimicrobial Resis-tance. ‘The Path of Least Resistance — main report’. London: DoH, 2000.  

Useful website  

www.advisorybodies.doh.gov.uk/smac1.htm — DoH  

Dr Louise Newson is a GP in the West Midlands and author of ‘Hot Topics for General Practitioners’, PasTest 2006 

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