Trial reportBMJ (Clinical research ed.)2014
Delayed antibiotic prescribing strategies for respiratory tract infections in primary care: pragmatic, factorial, randomised controlled trial.
Trial report in BMJ (Clinical research ed.), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02246361 (Impact of Six Patient Information Leaflets), which is not on this map. Cited by 88 papers, 9 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Impact of Six Patient Information Leaflets (PIL) on Doctor Patient Communication and Adherence in Emergency Ward
Who cites it
88 citing papers in PubMed, 9 syntheses or guidelines pooled it.
- Pooled it
- Immediate versus delayed versus no antibiotics for respiratory infections.The Cochrane database of systematic reviews · 2023Pooled it
- Information about the natural history of acute infections commonly seen in primary care: a systematic review of clinical practice guidelines.BMC infectious diseases · 2022Pooled it
- Delayed antibiotic prescribing for respiratory tract infections: individual patient data meta-analysis.BMJ (Clinical research ed.) · 2021Pooled it
- Systematic review of patient-oriented interventions to reduce unnecessary use of antibiotics for upper respiratory tract infections.Systematic reviews · 2020Pooled it
- Patients and investigators prefer measures of absolute risk in subgroups for pragmatic randomized trials.Journal of clinical epidemiology · 2018Pooled it
- The mortality risk of deferring optimal medical therapy in heart failure: a systematic comparison against norms for surgical consent and patient information leaflets.European journal of heart failure · 2017 · on this mapPooled it
- Delayed antibiotic prescriptions for respiratory infections.The Cochrane database of systematic reviews · 2017Pooled it
- Pooled it
- Using a decision support tool to reduce inappropriate antibiotic use after a delayed prescription.Applied psychology. Health and well-being · 2026Trial
- Qualitative interview study of antibiotics and self-management strategies for respiratory infections in primary care.BMJ open · 2017Trial
- [Antibiotic use: psychological factors influencing perceptions and behavior of physicians and patients].Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz · 2026Review
- Immune and Stem Cell-Mediated Bactericidal Amplification and Bone Remodeling for Infection Clearance and Osteointegration.Advanced materials (Deerfield Beach, Fla.) · 2026Article
- Prescribing and Dispensing Delayed Antibiotics for Pediatric Patients with Otitis Media and Pharyngitis.The Canadian journal of hospital pharmacy · 2026Article
- Administrative interventions in antimicrobial stewardship: a global scoping review of all WHO regions.Frontiers in pharmacology · 2026Review
- Saline nasal irrigation for acute sinusitis (SNIFS II): a randomised controlled pilot trial with nested process evaluation.BJGP open · 2025Article
- The 2023 Garrod Lecture: Antimicrobial use and stewardship in primary care: what works, and what next?The Journal of antimicrobial chemotherapy · 2025Article
- Outpatient antibiotic stewardship during the COVID-19 era: analysis of prescribing trends and guideline compliance.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- How, why and when are delayed (back-up) antibiotic prescriptions used in primary care? A realist review integrating concepts of uncertainty in healthcare.BMC public health · 2024Review
- Interventions to de-implement unnecessary antibiotic prescribing for ear infections (DISAPEAR Trial): protocol for a cluster-randomized trial.BMC infectious diseases · 2024Article
28 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
objectiveTo estimate the effectiveness of different strategies involving delayed antibiotic prescription for acute respiratory tract infections.
designOpen, pragmatic, parallel group, factorial, randomised controlled trial.
settingPrimary care in the United Kingdom. PATIENTS: 889 patients aged 3 years and over with acute respiratory tract infection, recruited between 3 March 2010 and 28 March 2012 by 53 health professionals in 25 practices.
interventionsPatients judged not to need immediate antibiotics were randomised to undergo four strategies of delayed prescription: recontact for a prescription, post-dated prescription, collection of the prescription, and be given the prescription (patient led). During the trial, a strategy of no antibiotic prescription was added as another randomised comparison. Analysis was intention to treat.
main outcome measuresMean symptom severity (0-6 scale) at days 2-4 (primary outcome), antibiotic use, and patients' beliefs in the effectiveness of antibiotic use. Secondary analysis included comparison with immediate use of antibiotics.
resultsMean symptom severity had minimal differences between the strategies involving no prescription and delayed prescription (recontact, post-date, collection, patient led; 1.62, 1.60, 1.82, 1.68, 1.75, respectively; likelihood ratio test χ(2) 2.61, P=0.625). Duration of symptoms rated moderately bad or worse also did not differ between no prescription and delayed prescription strategies combined (median 3 days v 4 days; 4.29, P=0.368). There were modest and non-significant differences in patients very satisfied with the consultation between the randomised groups (79%, 74%, 80%, 88%, 89%, respectively; likelihood ratio test χ(2) 2.38, P=0.667), belief in antibiotics (71%, 74%, 73%, 72%, 66%; 1.62, P=0.805), or antibiotic use (26%, 37%, 37%, 33%, 39%; 4.96, P=0.292). By contrast, most patients given immediate antibiotics used antibiotics (97%) and strongly believed in them (93%), but with no benefit for symptom severity (score 1.76) or duration (median 4 days).
conclusionStrategies of no prescription or delayed antibiotic prescription result in fewer than 40% of patients using antibiotics, and are associated with less strong beliefs in antibiotics, and similar symptomatic outcomes to immediate prescription. If clear advice is given to patients, there is probably little to choose between the different strategies of delayed prescription.
trial registrationISRCTN38551726.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.