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Concerns Regarding Back up/Delayed Prescribing

In this video Paul highlights concerns that have been raised about using back up/delayed antibiotic prescribing in practice.
OK. So there is a place for it. It doesn’t need to be all the time. What are the concerns that people commonly have about using it? Well, the first– I think the commonest concern is if I use this, people are just going to go out and use it. Well, that’s true. Some people will. But if you do delayed description properly, I think all the trials will show that if you give clear advice, use the six R’s– there will be relatively low antibiotic use. The second common concern is this giving mixed messages. And again, I think there is that capacity to give mixed messages if you say well, I just i’m not sure. Maybe I’ll take this in a few days.
Clearly, that’s giving them a mixed message. But the whole point about this is say you do not need antibiotics now. And certainly if you use the six R’s, there is no evidence that you are giving mixed messages at all. The belief in antibiotics is very similar comparing no or a delayed prescription. So the message is, you don’t need antibiotics now and you’re going to get side effects if you do. Very, very occasionally people will need to use the antibiotic. But I would only use the antibiotic in the following situation. So it’s doing it properly– the six R’s. The third thing is– the common concern is it’s not as effective as no offer of a prescription. Yeah. That’s absolutely true.
You will get slightly higher rates of antibiotic use. But if it’s done properly, the rates of antibiotic use will be in the mid to low 30%, which is fine. Having said that, I don’t think most people needed a delayed prescription. I would keep it for the ones where you’re a little bit worried. Certainly people that you’re really not worried about at all, I would do no prescription. If you use it compared to using an immediate antibiotic, it will reduce the number of people who come back to see you by about a third. So it’ll save you time. Fourthly, people are worried about medical legal consequences.
If I use this and somebody has a complication, am I going to get into trouble? Well, we now know from two big cohorts that the complication rate is reduced by both immediate and a delayed antibiotic. So that data is out there now, and can be referred to if this ever came up. Complications will occur. They still occur when you have immediate antibiotics. They will occur if you have delayed antibiotics. But they are about the same in both. They will occur more if you have no antibiotics. So that’s why the idea of targeting antibiotics flexibly is sensible. Lastly, will it take so much more time?
I think the first time you use a delayed prescription, and for a while getting used to the sensible things you have to say– yeah, it will take a bit more time. But most of those six R’s, you have to do anyway. The bit about delayed prescription is explaining the natural history, and explaining clearly when they should use it. So it is a little bit extra. But most of us say the six R’s, you’re going to be doing anyway.

Paul highlights concerns that have been raised about using back up/delayed antibiotic prescribing in practice.

The most important note to take away from this presentation by Prof. Paul Little, is that if you use delayed prescription properly, give clear advice, and use the six R’s; there will be relatively low antibiotic use needed.

There is also an important discussion on mixed messages and the importance of being really clear on saying to your patients that ‘you do not need antibiotics now’.

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TARGET Antibiotics – Prescribing in Primary Care

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