The impact of an immediate or delayed antibiotic prescription on reconsultations, hospital admission and death for LRTI
Lower respiratory tract infection (LRTI) is the commonest acute infection presenting in primary care. Antibiotics are commonly prescribed - despite little benefit for symptoms and the danger of antibiotic resistance. Prescribing continues in part because of concerns about prolonged illness and about complications, but there is very limited trial or observational evidence regarding either outcome.
Adult patients presenting in UK general practice with lower respiratory tract infections had symptoms signs and antibiotic prescribing strategies were recorded. Participants were followed-up for 30 days to document reconsultation with new or non–resolving symptoms, and hospitalisation or death. Multivariate analysis controlled for variables significantly related to the propensity to prescribe antibiotics and for clustering by general practitioner.
Outcomes were documented among 28867 participants. Hospitalisation or death occurred in 65/7366 (0.88%) following no antibiotic prescription, 189/17680 (1.1%) an immediate prescription and 19/3821 (0.5%) a delayed prescription (0.5%). Reconsultations for new or worsening symptoms was more common, being found in 1456/7366 (19.8%), 4484/17680 (25,4%) and 540/3821 (14%) respectively. Multivariate analysis documented no impact on reconsultations following immediate antibiotics (risk ratio 0.98, 95% confidence intervals 0.91 to 1.05, p=0.555) but a reduction associated with delayed prescriptions (0.67, 0.59 to 0.72, p<0.001). Hospitalisation and death were reduced follwing both immediate antibiotics (0.50, 0.32 to 0.81, p=0.004) and delayed antibiotics (0.47, 0.28 to 0.80, p=0.006).
For presentations of LRTI in primary care both immediate or delayed antibiotic halve the incidence of hospitalisation or death, but most patients do not need antibiotics as such major adverse events are uncommon. If clinicians are considering antibiotics a delayed prescription may be preferable since it is also associated with reduced reconsultations with new or worsening symptoms.