The so-called deferred prescription of antibiotics is a strategy to reduce the inappropriate use of these medications, which can be helpful in addressing the serious global problem of bacterial resistance. This strategy has been shown to be slightly more efficient than immediate prescription and non-prescription of antibiotics and is perceived as a useful tool by professionals in situations of uncertainty, according to two new studies published by researchers from the Sant Pau Research Institute and the Ibero-American Cochrane Center.
In the first study, researchers conducted a cost-effectiveness analysis, comparing deferred prescription to immediate prescription and non-prescription of antibiotics. The analysis included data from a clinical trial conducted by the research group, showing that deferred prescription was slightly more efficient than immediate prescription and non-prescription of antibiotics.
Dr. Pablo Alonso, Director of the Epidemiology and Public Health and Primary Care Area at IR Sant Pau, researcher at the Ibero-American Cochrane Center, and principal investigator of this line of work, states that “deferred treatment in the pediatric population showed slightly superior results than other strategies, even when considering the costs of bacterial resistance”.
In the second study, researchers explored the perceptions and attitudes of primary care professionals regarding antibiotics and deferred prescription as a treatment for adult patients with respiratory infections. The study showed that this prescription strategy was useful for professionals in situations of diagnostic uncertainty, providing patients with a safety net in managing their health problem and representing an opportunity to educate patients about the proper use of antibiotics, giving them greater autonomy.
Researcher Gemma Mas, professor at the Sant Pau Nursing School, coordinator of the Nursing Care Research Group, and first author of both studies, points out that “deferred prescription is used by professionals in cases of doubt and, in very specific situations, such as before the weekend when the patient cannot consult their primary care center again in case of deterioration.” She adds, “deferred prescription is an opportunity to educate the population about these types of infections, antibiotics, and when they are necessary“.
Patients more involved in their treatment
These Sant Pau experts explain that deferred prescription implies that, in cases where the pediatrician or family doctor is unsure whether the infection is bacterial or viral and, therefore, uncertain about the need to prescribe antibiotics to a patient based on their clinical condition at that time, a prescription is given, and the patient or responsible person is also informed about the natural history of the disease and when they should consider using the prescription. “The days during which the child may have these symptoms and what the warning signs would be. Thus, parents or the affected person can assess whether, after a few days, they need to use this prescription or not. In other words, they are given structured advice and guidelines based on the progression of the disease“,emphasizes Dr. Gemma Mas, who highlights that this strategy provides a safety net, empowers patients, and educates them about the proper use of antibiotics.
“For example, in the case of an ear infection, we can explain that if the patient does not improve after 3 days, or if they are much worse after 24 hours, it is necessary to consider using the prescription we have given them“. In this example, if the child improves, unnecessary use of an antibiotic is avoided – with its associated adverse effects and the risk of resistance – or the need to return to the doctor to seek a prescription in case of worsening, as explained by Dr. Gemma Mas.
Dr. Pablo Alonso comments that, although deferred prescription is only relatively implemented in primary care centers in Catalonia, there is still room for improvement. Lack of specificity in clinical guidelines and the need for more detailed tools were identified as areas for improvement for a more effective implementation of this strategy.
In summary, deferred prescription of antibiotics emerges as a valuable tool, not only to reduce costs and bacterial resistance but also to empower patients and educate about the real need for antibiotics in specific cases.
These experts emphasize that this deferred prescription strategy “is a patient-centered approach, providing us with a great opportunity to educate and empower them for decision-making“.
Patient satisfaction, resistance, and system sustainability
Dr. Joaquín López-Contreras, director of the Infectious Diseases Unit and responsible for the Nosocomial Infections and Antibiotic Policy Program at Sant Pau Hospital, indicates that “the use of deferred prescription in primary care is a strategy that has shown savings in the use of unnecessary antibiotics and, therefore, should have an impact on the progression of bacterial resistance in the community“.
From his point of view, these studies provide scientific evidence, “now it is necessary to analyze why this strategy, which has already demonstrated its effectiveness, is not implemented one hundred percent, and we must try to generalize it since, in addition to being positive in terms of patient satisfaction and resistance evolution, it is efficient in an economic sense, and this is also important to contribute to the sustainability of the health system“.
Dr. López-Contreras has emphasized that there is a correlation between the use of antibiotics and the percentage of resistance in different geographical areas of the world. “Southern European countries and countries in South Asia are very important consumers of antibiotics. Performing these types of interventions in Primary Care that educate citizens about the importance of the proper use of antibiotics and also help reduce their use seems to me a good strategy, with a global approach, to reduce the significant health problem posed by bacterial resistance”.
Trust and a good doctor-patient relationship are key factors in implementing this strategy, explains Dr. María Quinteiro, a pediatrician at the Sardenya Primary Care Center, who regularly uses deferred prescription in her practice. “I think it is very important that as a professional, you know the patient to whom you are explaining this, that you are able to trust them and provide adequate support, and that they also trust you to carry out what you are explaining correctly. Education is key“.
This pediatrician explains that the more active patients are and the more they are involved in their disease, the better clinical outcomes are usually achieved. “But that’s why previous education and support are needed; otherwise, it is impossible“.
Especially useful tool in primary care
Dr. Albert Boada Valmaseda, a reference in Primary Care in the Care Area of Catsalut, recalls that antibiotic resistance is a global problem, considered one of the main threats to health and humanity by the WHO. “Primary Care is the main prescriber of antibiotics in the community, and respiratory infections are the main etiology for which they are prescribed. Often, this prescription is inappropriate, given the main viral origin of these infections. That is why it is necessary to provide strategies to reduce the inappropriate prescription of antibiotics“.
From the perspective of this expert, “deferred prescription of antibiotics should be a strategy to promote in primary care for respiratory infections, as it is the area of highest prescription and is well accepted by professionals and patients. These studies increase knowledge about professionals’ perception of its use and cost-effectiveness”.
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