‘Wait-and-see’ a script to success
DOCTORS should hand out antibiotic prescriptions for sore throats, but tell patients not to take them straight away.
Instructing people not to “cash in” a prescription unless symptoms persisted was as effective as giving them the drugs immediately, researchers found.
People given a so-called “delayed prescription” – where they were asked to wait a few days first to see if symptoms improved – were less likely to use antibiotics unless they really needed them.
If GPs use the method, it could reduce the amount of antibiotics needlessly given out for sore throats and reduce the growing threat from antibiotic resistance.
A parallel study also suggested shorter courses of antibiotics for sore throats could be just as effective and help reduce overconsumption of antibiotics.
Antibiotic resistance, now considered a global health crisis, is mainly caused by over-prescription of the drugs.
This encourages bacteria to evolve to become immune to antibiotics and develop into deadly superbugs.
For the first study, researchers from the University of Southampton followed thousands of patients. Those given immediate antibiotics for a sore throat found their symptoms started to get better within two to four days – about a day sooner than those given no prescription at all.
But patients given a delayed prescription experienced similar improvements in symptoms in the same time frame.
Researchers suggested this was because many infections cleared up on their own with no need for antibiotics, while patients felt reassured by the knowledge they had a prescription they could use just in case.
And it meant those whose symptoms did not improve could get the medication they needed without having to go back to the GP.
Professor Michael Moore, of the University of Southampton, and his co-authors wrote: “GPs have been shown to overestimate the patient demand for antibiotics and the use of a delayed strategy would be one way of countering this.
“If most of those with intermediate symptom severity were offered a delayed prescription, the total uptake of antibiotics would be reduced with no anticipated adverse effects for symptom control, complications, or re-consultation.”
The parallel study, also led by Moore and published in the British Journal of General Practice, suggested prescribing antibiotics for five days was just as effective as the recommended 10-day course.
Patients with a sore throat, suspected to be caused by a streptococcal infection, were given antibiotics – usually penicillin – for five, seven or 10 days. Those on the 10-day course were slightly less likely than those on the five-day course to revisit their GP to complain of new or persisting symptoms. But the difference was too small to be statistically significant.
The researchers suggested this showed a shorter course could be as effective, but help reduce exposure to antibiotics. But they said it was important the theory was tested in controlled trials before GPs were recommended to prescribe shorter courses.
The findings follow a major Oxford University and Brighton and Sussex Medical School review, published in the BMJ, which suggested patients should not always take the full course of antibiotics if they began to feel better.
Professor Helen Stokes-Lampard, chairperson of the Royal College of GPs, said it was vital patients followed their GP’s advice when prescribed antibiotics. – Daily Mail