Spurling G K P, Del Mar C B, Dooley L, Foxlee R
University of Queensland, Discipline of General Practice, Level 2, Edith Cavell Building, Royal Brisbane Hospital, Brisbane, Queensland, Australia, 4029.
Cochrane Database Syst Rev. 2007 Jul 18(3):CD004417. doi: 10.1002/14651858.CD004417.pub3.
Modest benefits of antibiotics for acute upper respiratory tract infections have to be weighed against common adverse reactions, cost and antibacterial resistance. There has been interest in ways to reduce antibiotic prescribing. One strategy is to provide the prescription, but advise delay of more than 48 hours before use, in the hope symptoms resolve first. Advocates suggest this will preserve patient satisfaction. This review asks what effect delayed antibiotics have on clinical outcomes of respiratory infections, antibiotic use and patient satisfaction.
To evaluate the prescribing strategy of delayed antibiotics for acute respiratory tract infections compared to immediate or no antibiotics for clinical outcomes, antibiotic use and patient satisfaction.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2006); MEDLINE (January 1966 to January Week 2, 2007), EMBASE (1990 to Week 2, 2007) and Current Contents - ISI Web of Knowledge (1998 to January 2007).
Randomised controlled trials (RCTs) involving patients of all ages defined as having an acute respiratory infection were included in which delayed antibiotics were compared to antibiotics used immediately or no antibiotics. Outcomes measured included clinical outcomes, antibiotic use and patient satisfaction.
Data were collected and analysed by three review authors.
Nine trials were eligible on the basis of design and relevant outcomes. For most clinical outcomes there was no difference between delayed, immediate and no antibiotics. Antibiotics prescribed immediately were more effective than delayed for fever, pain and malaise in some studies of patients with acute otitis media and sore throat but for other studies there was no difference. There was no difference for the common cold and bronchitis. Delaying antibiotic prescriptions reduced antibiotic use, and in three studies, reduced patient satisfaction compared to immediate antibiotics. In the other two studies comparing delayed and immediate antibiotics measuring satisfaction, there was no difference. Two studies also included a 'no antibiotics' arm for bronchitis and sore throat: there was no difference in symptom resolution nor patient satisfaction from antibiotic delay. In one study, but not the other, antibiotic use was significantly decreased with no, rather than delayed, antibiotics.
AUTHORS' CONCLUSIONS: For most clinical outcomes there is no difference between the strategies. Immediate antibiotics was the strategy most likely to provide the best clinical outcomes in patients with sore throat and otitis media. Delaying or avoiding antibiotics, rather than providing them immediately, reduces antibiotic use for acute respiratory infections. Delay also reduced patient satisfaction in three trials, compared to immediate antibiotics with no difference in two other trials. Delaying antibiotics seems to have little advantage over avoiding them altogether where it is safe to do so.
抗生素对急性上呼吸道感染的益处有限，必须权衡其常见不良反应、成本和抗菌耐药性。人们一直在探索减少抗生素处方的方法。一种策略是开具处方，但建议在使用前延迟48小时以上，希望症状能先自行缓解。倡导者认为这样能保持患者满意度。本综述旨在探讨延迟使用抗生素对呼吸道感染临床结局、抗生素使用及患者满意度的影响。
评估与立即使用抗生素或不使用抗生素相比，延迟使用抗生素治疗急性呼吸道感染在临床结局、抗生素使用及患者满意度方面的处方策略。
我们检索了Cochrane对照试验中心注册库（CENTRAL）（Cochrane图书馆，2006年第4期）；MEDLINE（1966年1月至2007年1月第2周）、EMBASE（1990年至2007年第2周）以及《期刊目次 - ISI科学网》（1998年至2007年1月）。
纳入所有年龄组被定义为患有急性呼吸道感染患者的随机对照试验（RCT），其中将延迟使用抗生素与立即使用抗生素或不使用抗生素进行比较。测量的结局包括临床结局、抗生素使用及患者满意度。
由三位综述作者收集和分析数据。
基于设计和相关结局，有9项试验符合要求。对于大多数临床结局，延迟使用抗生素、立即使用抗生素和不使用抗生素之间没有差异。在一些急性中耳炎和喉咙痛患者的研究中，立即开具的抗生素在缓解发热、疼痛和不适方面比延迟使用更有效，但在其他研究中则没有差异。对于普通感冒和支气管炎，没有差异。与立即开具抗生素相比，延迟抗生素处方减少了抗生素的使用，在三项研究中，延迟使用抗生素降低了患者满意度。在另外两项比较延迟和立即使用抗生素并测量满意度的研究中，没有差异。两项研究还纳入了针对支气管炎和喉咙痛的“不使用抗生素”组：延迟使用抗生素在症状缓解和患者满意度方面与不使用抗生素没有差异。在一项研究中（而非另一项），不使用抗生素而非延迟使用抗生素显著减少了抗生素的使用。
对于大多数临床结局，这些策略之间没有差异。立即使用抗生素是最有可能为喉咙痛和中耳炎患者提供最佳临床结局的策略。延迟或避免使用抗生素，而不是立即提供抗生素，可减少急性呼吸道感染的抗生素使用。与立即使用抗生素相比，延迟使用抗生素在三项试验中降低了患者满意度，在另外两项试验中没有差异。在安全的情况下，延迟使用抗生素似乎并不比完全避免使用抗生素有更大优势。
