ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2021
The Safety of Delayed Versus Immediate Antibiotic Prescribing for Upper Respiratory Tract Infections.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.
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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.
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Who cites it
8 citing papers in PubMed, 2 syntheses or guidelines pooled it, 9 citations in OpenAlex.
- Immediate versus delayed versus no antibiotics for respiratory infections.The Cochrane database of systematic reviews · 2023Pooled it
- Delayed antibiotic prescriptions for respiratory infections.The Cochrane database of systematic reviews · 2017Pooled it
- Diagnostic Performance of the MeMed BV Test to Distinguish Between Bacterial and Viral or Other Non-Bacterial Causes Amongst ED and Urgent Care Patients: A Systematic Review with Meta-Analysis.Diagnostics (Basel, Switzerland) · 2026Review
- Antimicrobial stewardship strategies and programs in the outpatient settings: a scoping review.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Review
- Article
- Primary Care Antibiotic Prescribing and Infection-Related Hospitalisation.Antibiotics (Basel, Switzerland) · 2023Review
- The impact of COVID-19 on antibiotic prescribing in primary care in England: Evaluation and risk prediction of appropriateness of type and repeat prescribing.The Journal of infection · 2023Article
- Lemierre's Syndrome: A Case of Life-Threatening Infection From Family Medicine Practice.Cureus · 2021Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThis study aimed to evaluate the clinical safety of delayed antibiotic prescribing for upper respiratory tract infections (URTIs), which is recommended in treatment guidelines for less severe cases.
methodsTwo population-based cohort studies used the English Clinical Practice Research Databank and Welsh Secure Anonymized Information Linkage, containing electronic health records from primary care linked to hospital admission records. Patients with URTI and prescriptions of amoxicillin, clarithromycin, doxycycline, erythromycin, or phenoxymethylpenicillin were identified. Patients were stratified according to delayed and immediate prescribing relative to URTI diagnosis. Outcome of interest was infection-related hospital admission after 30 days.
resultsThe population included 1.82 million patients with an URTI and antibiotic prescription; 91.7% had an antibiotic at URTI diagnosis date (immediate) and 8.3% had URTI diagnosis in 1-30 days before (delayed). Delayed antibiotic prescribing was associated with a 52% increased risk of infection-related hospital admissions (adjusted hazard ratio, 1.52; 95% confidence interval, 1.43-1.62). The probability of delayed antibiotic prescribing was unrelated to predicted risks of hospital admission. Analyses of the number needed to harm showed considerable variability across different patient groups (median with delayed antibiotic prescribing, 1357; 2.5% percentile, 295; 97.5% percentile, 3366).
conclusionsThis is the first large population-based study examining the safety of delayed antibiotic prescribing. Waiting to treat URTI was associated with increased risk of hospital admission, although delayed antibiotic prescribing was used similarly between high- and low-risk patients. There is a need to better target delayed antibiotic prescribing to URTI patients with lower risks of complications.
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