Back up/Delayed Prescribing: the Evidence

So what’s the place of delayed prescription or backup prescription? Well, the first trial we did, bit of an old chestnut, we looked at three strategies– no offer antibiotics, immediate, or delayed. And these are the three strategies, if you like, in each of these sets of columns. That’s antibiotic, no antibiotic, or delayed. And as you can see, didn’t make any difference to whether people got better in a few days, no difference to people being satisfied with the consultation. But by prescribing an immediate antibiotic, you are hugely increased in the belief in antibiotics and increasing intention to consult. And when we followed this cohort for a year, there was about a 40% relative increase in consultations.

So the interesting thing was that, although antibiotics medicalise the illness, delayed antibiotics, no antibiotics had about the same effect. So quite an interesting finding. But basically, even one antibiotic was pretty strongly medicalising, fuelling reconsultations, fuelling antibiotic use. OK, the next thing is, how does it apply to other studies? Or is it just a thing we can use in sore throat? Well, the next study we did, if you like, was some otitis media. And as you can see, actually immediate compared to delayed, you did get a difference in duration of around a day, but that was at the stage when the illness is much milder anyway, as is shown by this next slide.

So as you can see, level of pain six out of 10 in the first day. Pretty painful illness. The child is unwell. You’re up at night with them. But even after another three to four hours, it’s down by about a half and just goes down exponentially. And antibiotics make a very slight difference, but really not significant in that time period. So for otitis, it’s not doing terribly much. Chest infections was the next thing. These estimates, those little dots in the middle of the estimates, comparing delayed or antibiotics with no antibiotics. And these are the confidence intervals. And basically, what this shows is for all of these outcomes, cough duration, moderately bad duration, or severity, we really weren’t doing anything.

We’ve looked at other conditions, related conditions– conjunctivitis, similar story really. No major difference between an immediate prescription of antibiotic drops and a delayed prescription of antibiotic drops.