SynthesisBMJ (Clinical research ed.)2021
Delayed antibiotic prescribing for respiratory tract infections: individual patient data meta-analysis.
Synthesis in BMJ (Clinical research ed.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 42 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
42 citing papers in PubMed, 2 syntheses or guidelines pooled it, 76 citations in OpenAlex.
- [Early source control of infection in patients seen in the emergency department: a systematic review].Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2024Pooled 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
- Using a decision support tool to reduce inappropriate antibiotic use after a delayed prescription.Applied psychology. Health and well-being · 2026Trial
- Rapid Respiratory Microbiological Point-of-Care Testing and Antibiotic Use in Primary Care: A Randomized Clinical Trial.JAMA internal medicine · 2026Trial
- Antibiotic effectiveness for children with lower respiratory infections: prospective cohort and trial in primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2023Trial
- When Antibiotics Are Refused: A Qualitative Study of Patient-Provider Communication, Trust, and Reported or Anticipated Responses in Jordan.Healthcare (Basel, Switzerland) · 2026Article
- Paediatric outpatient antibiotic utilization patterns and use of healthcare services before, during and after the COVID-19 pandemic: interrupted time series analysis using data from Norway and Japan.The Journal of antimicrobial chemotherapy · 2026Article
- Antibiotic timing and progression to sepsis among patients in the ED for infection.European journal of medical research · 2026Article
- Prescribing and Dispensing Delayed Antibiotics for Pediatric Patients with Otitis Media and Pharyngitis.The Canadian journal of hospital pharmacy · 2026Article
- Tranexamic Acid for Acute Upper Respiratory Tract Infection-Associated Sore Throat Pain: A Randomized Controlled Trial.Journal of general and family medicine · 2026Article
- Article
- Model-based cost-impact analysis of a diagnostic test for patients with community-acquired pneumonia in Canada.BMC infectious diseases · 2025Article
- Barriers and facilitators for the implementation of delayed-prescription of antibiotics in family medicine: a qualitative study.BMC health services research · 2025Article
- Increasing Safety Net Antibiotic Prescriptions for Acute Otitis Media in Urgent Care Clinics.Journal of pediatrics. Clinical practice · 2024Article
- Appropriateness of intended antibiotic prescribing using clinical case vignettes in primary care, and related factors.The European journal of general practice · 2024Article
- Article
- 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
- Quality improvement initiative to reduce URI-associated antibiotic prescriptions among adult primary care providers.BMJ open quality · 2024Article
- C-reactive protein point-of-care testing in primary care-broader implementation needed to combat antimicrobial resistance.Frontiers in public health · 2024Review
- Protocol for the development of an intervention to improve the use of Point-of-caRE DiagnostICs in the management of respiraTOry tRact infectionS in primary care (the PREDICTORS study).HRB open research · 2024Article
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
24 authors at 15 institutions in 6 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess the overall effect of delayed antibiotic prescribing on average symptom severity for patients with respiratory tract infections in the community, and to identify any factors modifying this effect.
designSystematic review and individual patient data meta-analysis. DATA SOURCES: Cochrane Central Register of Controlled Trials, Ovid Medline, Ovid Embase, EBSCO CINAHL Plus, and Web of Science. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Randomised controlled trials and observational cohort studies in a community setting that allowed comparison between delayed versus no antibiotic prescribing, and delayed versus immediate antibiotic prescribing.
main outcome measuresThe primary outcome was the average symptom severity two to four days after the initial consultation measured on a seven item scale (ranging from normal to as bad as could be). Secondary outcomes were duration of illness after the initial consultation, complications resulting in admission to hospital or death, reconsultation with the same or worsening illness, and patient satisfaction rated on a Likert scale.
resultsData were obtained from nine randomised controlled trials and four observational studies, totalling 55 682 patients. No difference was found in follow-up symptom severity (seven point scale) for delayed versus immediate antibiotics (adjusted mean difference -0.003, 95% confidence interval -0.12 to 0.11) or delayed versus no antibiotics (0.02, -0.11 to 0.15). Symptom duration was slightly longer in those given delayed versus immediate antibiotics (11.4
conclusionsDelayed antibiotic prescribing is a safe and effective strategy for most patients, including those in higher risk subgroups. Delayed prescribing was associated with similar symptom duration as no antibiotic prescribing and is unlikely to lead to poorer symptom control than immediate antibiotic prescribing. Delayed prescribing could reduce reconsultation rates and is unlikely to be associated with an increase in symptoms or illness duration, except in young children. STUDY REGISTRATION: PROSPERO CRD42018079400.
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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.