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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Article

Delayed Antibiotic Prescription for Children With Respiratory Infections: A Randomized Trial

Gemma Mas-Dalmau, Carmen Villanueva López, Pedro Gorrotxategi Gorrotxategi, Emma Argüelles Prendes, Oscar Espinazo Ramos, Teresa Valls Duran, María Encarnación Gonzalo Alonso, María Pilar Cortés Viana, Tatiana Menéndez Bada, Marta Esther Vázquez Fernández, Ana Isabel Pérez Hernández, Laura Muñoz Ortiz, Paul Little, Mariam de la Poza Abad, Pablo Alonso-Coello and ON BEHALF OF THE DAP PEDIATRICS GROUP*
Pediatrics March 2021, 147 (3) e20201323; DOI: https://doi.org/10.1542/peds.2020-1323
Gemma Mas-Dalmau
aIberoamerican Cochrane Center, and
bNursing Care Reserch Group, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain;
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Carmen Villanueva López
cManso Primary Care Center, Barcelona, Spain;
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Pedro Gorrotxategi Gorrotxategi
dPasai San Pedro Primary Care Center, Pasaia, Spain;
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Emma Argüelles Prendes
eRibadesella Primary Care Center, Ribadesella, Spain;
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Oscar Espinazo Ramos
fLas Matas Primary Care Center, Las Rozas de Madrid, Spain;
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Teresa Valls Duran
gVal Miñor Primary Care Center, Nigrán, Spain;
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María Encarnación Gonzalo Alonso
hUgao-Miraballes Primary Care Center, Ugao-Miraballes, Spain;
iArrigorriaga Primary Care Center, Arrigorriaga, Spain;
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María Pilar Cortés Viana
jMaragall Primary Care Center, Barcelona, Spain;
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Tatiana Menéndez Bada
kIruña de Oka Primary Care Center, Nanclares de Oka, Spain;
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Marta Esther Vázquez Fernández
lArturo Eyries Primary Care Center, Valladolid, Spain;
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Ana Isabel Pérez Hernández
mTorrelodones Primary Care Center, Torrelodones, Spain;
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Laura Muñoz Ortiz
nAgency for Health Quality and Assessment of Catalonia, Barcelona, Spain;
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Paul Little
oAldermoor Health Centre, Southampton, United Kingdom;
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Mariam de la Poza Abad
pDr Carles Ribas Primary Care Center, Barcelona, Spain; and
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Pablo Alonso-Coello
aIberoamerican Cochrane Center, and
qCIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
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OBJECTIVES: To assess the effectiveness and safety of delayed antibiotic prescription (DAP) compared to immediate antibiotic prescription (IAP) and no antibiotic prescription (NAP) in children with uncomplicated respiratory infections.

METHODS: Randomized clinical trial comparing 3 antibiotic prescription strategies. The participants were children with acute uncomplicated respiratory infections attended to in 39 primary care centers. Children were randomly assigned into prescription arms as follows: (1) DAP, (2) IAP, or (3) NAP. Primary outcomes were symptom duration and severity. Secondary outcomes were antibiotic use, parental satisfaction, parental beliefs, additional primary care visits, and complications at 30 days.

RESULTS: In total, 436 children were included in the analysis. The mean (SD) duration of severe symptoms was 10.1 (6.3) for IAP, 10.9 (8.5) for NAP, and 12.4 (8.4) for DAP (P = .539), although the differences were not statistically significant. The median (interquartile range) of the greatest severity for any symptom was similar for the 3 arms (median [interquartile range] score of 3 [2–4]; P = .619). Antibiotic use was significantly higher for IAP (n = 142 [96%]) compared to DAP (n = 37 [25.3%]) and NAP (n = 17 [12.0%]) (P < .001). Complications, additional visits to primary care, and satisfaction were similar for all strategies. Gastrointestinal adverse effects were higher for IAP.

CONCLUSIONS: There was no statistically significant difference in symptom duration or severity in children with uncomplicated respiratory infections who received DAP compared to NAP or IAP strategies; however, DAP reduced antibiotic use and gastrointestinal adverse effects.

  • Accepted November 18, 2020.
  • Copyright © 2021 by the American Academy of Pediatrics

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Pediatrics
Vol. 147, Issue 3
1 Mar 2021
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Delayed Antibiotic Prescription for Children With Respiratory Infections: A Randomized Trial
Gemma Mas-Dalmau, Carmen Villanueva López, Pedro Gorrotxategi Gorrotxategi, Emma Argüelles Prendes, Oscar Espinazo Ramos, Teresa Valls Duran, María Encarnación Gonzalo Alonso, María Pilar Cortés Viana, Tatiana Menéndez Bada, Marta Esther Vázquez Fernández, Ana Isabel Pérez Hernández, Laura Muñoz Ortiz, Paul Little, Mariam de la Poza Abad, Pablo Alonso-Coello, ON BEHALF OF THE DAP PEDIATRICS GROUP*
Pediatrics Mar 2021, 147 (3) e20201323; DOI: 10.1542/peds.2020-1323

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Delayed Antibiotic Prescription for Children With Respiratory Infections: A Randomized Trial
Gemma Mas-Dalmau, Carmen Villanueva López, Pedro Gorrotxategi Gorrotxategi, Emma Argüelles Prendes, Oscar Espinazo Ramos, Teresa Valls Duran, María Encarnación Gonzalo Alonso, María Pilar Cortés Viana, Tatiana Menéndez Bada, Marta Esther Vázquez Fernández, Ana Isabel Pérez Hernández, Laura Muñoz Ortiz, Paul Little, Mariam de la Poza Abad, Pablo Alonso-Coello, ON BEHALF OF THE DAP PEDIATRICS GROUP*
Pediatrics Mar 2021, 147 (3) e20201323; DOI: 10.1542/peds.2020-1323
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