Does Back up/Delayed Prescribing Prevent Complications and Reconsultations?

So 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?

Well, 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.

The 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.

But 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.