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Delayed antibiotics are a bad idea.
New RCT. New thread. 1/12
@theresa_rowe1 and I wrote about this in @JAMA_current.
A new -- and very good -- RCT in Pediatrics confirms problems with delayed antibiotics as a strategy.
https://ja.ma/3aiSknS
New RCT. New thread. 1/12
@theresa_rowe1 and I wrote about this in @JAMA_current.
A new -- and very good -- RCT in Pediatrics confirms problems with delayed antibiotics as a strategy.
https://ja.ma/3aiSknS
2/12
The RCT from Drs. Gemma Mas-Dalmau, Mariam de la Poza Abad, and colleagues randomized 436 children with OM, pharyngitis, acute bronchitis, and sinusitis to:
1. Immediate Antibiotics (IAP)
2. Delayed Antibiotics (DAP)
3. No Antibiotics (NAP)
https://pediatrics.aappublications.org/content/early/2021/02/09/peds.2020-1323
The RCT from Drs. Gemma Mas-Dalmau, Mariam de la Poza Abad, and colleagues randomized 436 children with OM, pharyngitis, acute bronchitis, and sinusitis to:
1. Immediate Antibiotics (IAP)
2. Delayed Antibiotics (DAP)
3. No Antibiotics (NAP)
https://pediatrics.aappublications.org/content/early/2021/02/09/peds.2020-1323
3/12
The groups were well balanced.
The differences in 30-day antibiotic use were:
Immediate 96%
Delayed 25%
No-antibiotic 12%
The groups were well balanced.
The differences in 30-day antibiotic use were:
Immediate 96%
Delayed 25%
No-antibiotic 12%
4/12
So, delayed antibiotics "work," right?
So, delayed antibiotics "work," right?
5/12
That looks good, but...
...to the authors' credit, the primary outcomes -- there were 2...but I'll leave that aside for now -- were duration and severity of symptoms.
NO DIFFERENCE.
That looks good, but...
...to the authors' credit, the primary outcomes -- there were 2...but I'll leave that aside for now -- were duration and severity of symptoms.
NO DIFFERENCE.
6/12
In secondary outcomes, compared to no antibiotics, the IAP and DAP groups had more GI side effects and a much higher belief in the effectiveness of antibiotics.
In secondary outcomes, compared to no antibiotics, the IAP and DAP groups had more GI side effects and a much higher belief in the effectiveness of antibiotics.
7/12
So, as with prior RCTs of delayed antibiotic prescribing, we're proving that these patients DON'T NEED ANTIBIOTICS AT ALL.
Yes, there's a big difference in the antibiotic prescribing rate, but the standard of care shouldn't be bad care (immediate antibiotics)....
So, as with prior RCTs of delayed antibiotic prescribing, we're proving that these patients DON'T NEED ANTIBIOTICS AT ALL.
Yes, there's a big difference in the antibiotic prescribing rate, but the standard of care shouldn't be bad care (immediate antibiotics)....
8/12
If we are going to maximize effectiveness and safety for patients, the comparison group for delayed antibiotics should be the no antibiotic group.
Delayed antibiotics are to treat the prescriber not the patient.
If we are going to maximize effectiveness and safety for patients, the comparison group for delayed antibiotics should be the no antibiotic group.
Delayed antibiotics are to treat the prescriber not the patient.
9/12
Problems with delayed antibiotics:
1. They don't improve patient outcomes and expose patients to harm
2. Guidelines are pretty clear about when antibiotics help
3. Microbiology. These are viral infections
Problems with delayed antibiotics:
1. They don't improve patient outcomes and expose patients to harm
2. Guidelines are pretty clear about when antibiotics help
3. Microbiology. These are viral infections
10/12
4. Ignore the natural history of respiratory infections which generally last 7 to 21 days
5. Increase patients perception that antibiotics are necessary for self-limited illness (and increase care-seeking)
4. Ignore the natural history of respiratory infections which generally last 7 to 21 days
5. Increase patients perception that antibiotics are necessary for self-limited illness (and increase care-seeking)
11/12
6. Give a confusing, mixed message to patients
("you don't need an antibiotic, but here's an antibiotic")
6. Give a confusing, mixed message to patients
("you don't need an antibiotic, but here's an antibiotic")
12/12
Yes I am taking a hard line here.
Yes I'm sensitive to the pressure of patient satisfaction.
But even in this RCT there was no difference in patient satisfaction.
Delayed antibiotics...let's not.
The end.
Yes I am taking a hard line here.
Yes I'm sensitive to the pressure of patient satisfaction.
But even in this RCT there was no difference in patient satisfaction.
Delayed antibiotics...let's not.
The end.
