Interventions to influence the use of antibiotics for acute upper respiratory tract infections

Key Message

Thirteen systematic reviews (SRs) were identified. Two of these SRs addressed delayed antibiotic prescribing and 12 of these SRs investigated family medicine interventions. Delayed antibiotic prescribing reduced antibiotic use for upper respiratory tract infections (URTIs) compared to immediate prescribing and did not appear to impact patient satisfaction or re-consultation rates; however, there was less evidence on clinical outcomes, health care utilization, or antibiotic resistance. One systematic review concluded that there was no difference between delayed and immediate antibiotics for many clinical outcomes, but that immediate antibiotics may modestly improve symptoms for acute otitis media (AOM) and sore throat compared with delayed antibiotics.

Various family medicine interventions were evaluated; however, there were generally few relevant primary studies in each of these reviews for most of the interventions. Rapid or point-of-care tests to guide the treatment of URTIs appeared to reduce antibiotic prescribing compared to control or usual care; however, there was relatively little evidence on clinical outcomes for these tests. One systematic review on procalcitonin-guided treatment suggested that this intervention led to no difference in the number of days with restricted activities or rates of treatment failure compared to control, while another systematic review found that C-reactive protein (CRP) point-of-care tests to guide antibiotic prescribing resulted in no difference in recovery or time to resolution of the symptoms; however, this was based on only 2 randomized controlled trials (RCTs). Evidence was mixed on different patient- or provider-directed interventions, such as education, training, and tools. In some of the primary studies from the eligible SRs, these interventions reduced antibiotic prescribing; while in others, they had no effect on antibiotic prescribing.