Delayed Antibiotic Prescribing

Delayed Antibiotic Prescribing
Taylor Thooft, Pharm.D., Centra Care Health

A recent article published in the Journal of American Medicine (JAMA) calls into question the use of delayed antibiotic prescribing as an antimicrobial stewardship initiative. Delayed antibiotic prescribing refers to the practice of providing antibiotic prescriptions to patients in the ambulatory care setting with the expectation the patient would not fill the prescription unless improvement of symptoms was not seen within a few days.

Delayed antibiotic prescribing is currently recommended by the U.S. Centers for Disease Control and Prevention program Core Elements of Outpatient Antibiotic Stewardship as a potential action to promote appropriate antibiotic prescribing practice. Prescribers may utilize this practice to reduce overall use of antibiotics and avoid medicalization of self-limiting illnesses. Additionally, a 2017 Cochrane review suggests delayed antibiotic prescribing practices can significantly reduce antibiotic use; however, it also suggests delayed antibiotic prescribing practices do not improve patient outcomes in non-antibiotic-appropriate conditions such as cough, sore throat, and the common cold in comparison to immediate antibiotic prescribing. Delayed-antibiotic prescribing may also increase antibiotic-seeking behaviors in patients.

The JAMA article suggests reductions in antibiotic prescriptions observed through delayed antibiotic prescribing are driven largely by inappropriate initial use of antibiotics. Delayed antibiotic prescribing also presents notable logistical barriers to its implementation. First, the exact period of how long patients should wait before filling the prescription is poorly defined. Additionally, clinicians must decide how the prescription should be provided to the patient. Several strategies exist, such as the patient being provided a prescription immediately and instructed to wait before filling it, or providing the patient a post-dated prescription.

Overall, delayed antibiotic prescribing may not be the most optimal antimicrobial stewardship practice; however, it may provide some benefit in reducing overall antibiotic use. Using this practice in conjunction with other strategies such as education and training regarding antibiotic use, developing clinical decision making support systems, and utilizing promotional material within practice sites to raise patient awareness about appropriate antibiotic prescribing may improve stewardship efforts overall.

References:

  1. Rowe TA, Linder, JA. Delayed Antibiotic Prescriptions in Ambulatory Care: Reconsidering a Problematic Practice. JAMA. 2020. doi:10.1001/jama.2020.2325.

  2. US Centers for Disease Control and Prevention. Antibiotic Prescribing And Use In Doctor’s Offices; Outpatient Healthcare Professionals. Accessed May 6, 2020. https://www.cdc.gov/antibiotic-use/community/for-hcp/outpatient-hcp/index.html

  3. Spurling GKP, Del Mar CB, Dooley L, Foxlee R, Farley R. Delayed Antibiotic Prescriptions For Respiratory Infections. Cochrane Database Syst Rev. 2017.