Skip to 0 minutes and 9 secondsSo I'm now going to talk about the Descarte cohort, which actually addresses this in some detail. Because it allows us to look at whether antibiotics prevent complications and re-consultations and, in particular, what's the impact of delayed prescription, compared to an immediate prescription. So this is 13,000, more than 13,000 people-- a huge cohort, the biggest prospective cohorts done to date. And the bottom line-- complications are uncommon, no matter what you do, around 1%. And the complications are as you see-- Quinsy, which is pretty rare; sinusitis; otitis media, a little bit more common; and cellulitis or impetigo, which happens, again, fairly rarely, but will occur. So the big question is, does delayed prescribing prevent those?

Skip to 0 minutes and 59 secondsWell, if you allow for the-- if you like the propensity of GPs to prescribe antibiotics, which is very important to do in these observational studies, the adjusted risk ratios show that you get a risk ratio of 0.6 for antibiotics, means that there's a 40% reduction in complications. And for delayed antibiotics, there's a similar reduction-- so roughly halving the complication. So basically, antibiotics or delayed antibiotics will halve your complications or thereabouts, between 40% and 50% reduction. So there's definitely something there for individuals that you're a bit concerned about, who might be more likely to get a complication.

Skip to 1 minute and 39 secondsThe other thing that it's worth noting, which was very interesting to find, was delayed prescribing actually reduces re-consultations more effectively, in fact, than immediate antibiotics. So around 15% to 20% of people will come back within a month with either the same symptom or a progression of symptoms. And antibiotics will reduce that by 25%. So that's a risk ratio of 0.76. So that's about a 25% reduction. And the delayed antibiotic will reduce it by even a little bit more, so about 40%. In summary, really, what we've shown from the Descartes sore throat cohort-- and actually, we've got very, very similar data coming out now from a big study in chest infections, a 3C cohort-- complications are uncommon.

Skip to 2 minutes and 22 secondsBut if you're considering an antibiotic, they certainly will reduce complications and re-consultations. Re-consultations are even better with delayed prescription. So if you're considering an antibiotic, I would consider a delayed prescription for most of the time you are considering an antibiotic. It prevents complications, reduces re-consultations, and it's at least as effective as immediate antibiotics and will lower your antibiotic use.

Does Back up/Delayed Prescribing Prevent Complications and Reconsultations?

Can Back up/Delayed Prescribing Prevent Complications and Re-consultations?

In this presentation Paul will be looking at the Descarte cohort, which allows us to see whether antibiotics prevent complications and re-consultations, along with the impact of delayed prescription, compared to an immediate prescription.

The Descarte study of over 13000 patients with acute sore throat showed that back up/delayed antibiotics should be considered as a first choice option for many sore throats when antibiotics are being considered as they prevent complications, reduce re-consultations and are at least as effective as immediate antibiotics.

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TARGET Antibiotics – Prescribing in Primary Care

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