Delayed prescriptions or shorter courses of treatment could be a way of fighting antibiotic resistance

Two studies, led by the University of Southampton and published in the British Journal of General Practice, have highlighted effective ways of reducing antibiotic consumption without any disadvantage for patients.

The first study concluded that doctors could use antibiotic prescriptions for sore throats but tell patients not to take them straight away.

Issuing an antibiotic prescription with the instruction of not to ‘cash it in’ unless symptoms persisted was as effective as giving them the drugs immediately, and if people were given a ‘delayed prescription’ – where they were asked to wait a few days first to see if symptoms improved – they were less likely to use antibiotics unless they really needed them.

The second study shows that shorter courses of antibiotics for sore throats (a five-day course, instead of the ten-day course) could be just as effective and help reduce overconsumption of antibiotics.

Professor Michael Moore, who led both studies, commented: “Antibiotic resistance is now considered a global health crisis and one of the contributors is over-prescription of the drugs. We need to adopt new approaches if we are going to reduce our overreliance on antibiotics. A ‘wait and see’ approach seems to have similar benefits to a prescription on symptoms approach; and we found that less people end up using them.  A shorter course of antibiotics does not seem to have disadvantages and is another way of reducing exposure to antibiotics.”

Both studies were observational studies. The researchers followed thousands of patients who presented at their GP practice with a sore throat. In the first study, patients who were given antibiotics straight away started to recover around a day sooner than those given no prescription at all. Patients given a delayed prescription experienced a similar recovery rate to those given immediate antibiotics.

The research team believe this was because most infections clear 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. It also meant those whose symptoms did not improve could get the medication they needed without having to go back to the GP.

In the second study the researchers looked at those treated with an antibiotic and compared recovery rates for those given five, seven or ten days treatment. Those on the ten-day course were slightly less likely than those on the five-day course to revisit their GP with new or persisting symptoms. But the difference was very small and was not statistically significant.

The researchers commented that although current guidance was to use ten days antibiotics in practice shorter courses are used. 

Professor Moore added: “It does not appear from this data that shorter courses lead to more prolonged symptoms or a higher risk of needing a second visit to the doctor.

Adopting shorter courses could be an effective strategy to reduce exposure to antibiotics. However it is important to test this theory further in controlled trials before GPs guidelines are amended to recommend shorter courses.”