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Mas-Dalmau G, Villanueva Lopez C, Gorrotxategi Gorrotxategi P, et al. Delayed Antibiotic Prescription for Children With Respiratory Infections: A Randomized Trial. Pediatrics. 2021 Mar;147(3). pii: peds.2020-1323. doi: 10.1542/peds.2020-1323. Epub 2021 Feb 11. (Original study)
Abstract

OBJECTIVES: To assess the effectiveness and safety of delayed antibiotic prescription (DAP) compared to immediate antibiotic prescription (IAP) and no antibiotic prescription (NAP) in children with uncomplicated respiratory infections.

METHODS: Randomized clinical trial comparing 3 antibiotic prescription strategies. The participants were children with acute uncomplicated respiratory infections attended to in 39 primary care centers. Children were randomly assigned into prescription arms as follows: (1) DAP, (2) IAP, or (3) NAP. Primary outcomes were symptom duration and severity. Secondary outcomes were antibiotic use, parental satisfaction, parental beliefs, additional primary care visits, and complications at 30 days.

RESULTS: In total, 436 children were included in the analysis. The mean (SD) duration of severe symptoms was 10.1 (6.3) for IAP, 10.9 (8.5) for NAP, and 12.4 (8.4) for DAP (P = .539), although the differences were not statistically significant. The median (interquartile range) of the greatest severity for any symptom was similar for the 3 arms (median [interquartile range] score of 3 [2-4]; P = .619). Antibiotic use was significantly higher for IAP (n = 142 [96%]) compared to DAP (n = 37 [25.3%]) and NAP (n = 17 [12.0%]) (P < .001). Complications, additional visits to primary care, and satisfaction were similar for all strategies. Gastrointestinal adverse effects were higher for IAP.

CONCLUSIONS: There was no statistically significant difference in symptom duration or severity in children with uncomplicated respiratory infections who received DAP compared to NAP or IAP strategies; however, DAP reduced antibiotic use and gastrointestinal adverse effects.

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Nurse 7 / 7
Physician 6 / 7
Comments from MORE raters

Nurse rater

This is an extremely important clinical problem for children. The use of antibiotics should always be carefully considered based on the physical examination and clinical evaluation of the patient. The subject matter of this article is very valuable for the medical staff responsible for the therapy and treatment of children.

Nurse rater

This is a very useful article for pediatric patients with infectious Respiratory symptoms.

Physician rater

Due to its study design, the study findings are very compelling; although, prior studies have also reported similar findings.
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