Delayed Antibiotic Prescription for Children With Respiratory Infections: A Randomized Trial.

Autor:	Mas-Dalmau G; Iberoamerican Cochrane Center, and.; Nursing Care Reserch Group, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain., Villanueva López C; Manso Primary Care Center, Barcelona, Spain., Gorrotxategi Gorrotxategi P; Pasai San Pedro Primary Care Center, Pasaia, Spain., Argüelles Prendes E; Ribadesella Primary Care Center, Ribadesella, Spain., Espinazo Ramos O; Las Matas Primary Care Center, Las Rozas de Madrid, Spain., Valls Duran T; Val Miñor Primary Care Center, Nigrán, Spain., Gonzalo Alonso ME; Ugao-Miraballes Primary Care Center, Ugao-Miraballes, Spain.; Arrigorriaga Primary Care Center, Arrigorriaga, Spain., Cortés Viana MP; Maragall Primary Care Center, Barcelona, Spain., Menéndez Bada T; Iruña de Oka Primary Care Center, Nanclares de Oka, Spain., Vázquez Fernández ME; Arturo Eyries Primary Care Center, Valladolid, Spain., Pérez Hernández AI; Torrelodones Primary Care Center, Torrelodones, Spain., Muñoz Ortiz L; Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain., Little P; Aldermoor Health Centre, Southampton, United Kingdom., de la Poza Abad M; Dr Carles Ribas Primary Care Center, Barcelona, Spain; and., Alonso-Coello P; Iberoamerican Cochrane Center, and palonso@santpau.cat.; CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.
Jazyk:	angličtina
Zdroj:	Pediatrics [Pediatrics] 2021 Mar; Vol. 147 (3). Date of Electronic Publication: 2021 Feb 11.
DOI:	10.1542/peds.2020-1323
Abstrakt:	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. Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. (Copyright © 2021 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
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