Rationale, design and organization of the delayed antibiotic prescription (DAP) trial: a randomized controlled trial of the efficacy and safety of delayed antibiotic prescribing strategies in the non-complicated acute respiratory tract infections in general practice

Mariam de la Poza Abad, Gemma Mas Dalmau, Mikel Moreno Bakedano, Ana Isabel González González, Yolanda Canellas Criado, Silvia Hernández Anadón, Rafael Rotaeche del Campo, Pere Torán Monserrat, Antonio Negrete Palma, Guillem Pera, Eulàlia Borrell Thió, Carl Llor, Paul Little, Pablo Alonso Coello, Delayed Antibiotic Prescription (DAP) Working Group, Pablo Alonso-Coello, José Martínez Zapata, Gerard Urrutia Cuchí, Lorena Martínez Villamar, Ignasi Gich, Gemma Mas Dalmau, Mariam De la Poza Abad, Mercedes Liroz Navarro, Eulàlia Borrell Thió, Núria Barrera Aguilera, Maite Coll Perona, Asumpta Libre Saló, Marta Cañibano Gómez, Silvia Sierra Pujante, Marta Besa Castellà, Marisol Miguel Baquero, Maria Alsina Casalduero, Enric Serras Ricart, Victòria Bertran Fontelles, Pere Torán Monserrat, Antonio Negrete Palma, Roser Vallès Navarro, Rosa Coma Carbó, Maite Aizpurua Pérez, Josep Sorribas López, Guillem Pera, Laura Muñoz Ortiz, Ma del Mar Rodríguez Álvarez, Maria Bernades, Laura Ruipérez Guijarro, Ma Adela Viniegra Domínguez, Pere Josep Simonet Aineto, Carl Llor, Silvia Hernández Anadón, Aitor Alfaro Ormaolea, Ana Moragas Moreno, Mikel Moreno Bakedano, Miguel Ángel Senosiain Zabalegui, Pilar Arroyo Aniés, Carlos Amezqueta Goñi, Rafael Rotaeche del Campo, Naiara Campos Morey, Carmen Escribano Andrés, Ma José Seijas Martínez- Echevarria, Yolanda Canellas Criado, Sagrario Muñoz-Quirós Aliaga, Cristina Belló González, Alberto López García-Franco, Ma del Mar Álvarez Villalba, Juan Carlos Moreno Fernández, Marisol Lorenzo Borda, Carlos Aguilera Collado, José Antonio Pere Pedrol, Blanca Gutiérrez Teira, Francisco Ramón Abellán López, Mariam de la Poza Abad, Gemma Mas Dalmau, Mikel Moreno Bakedano, Ana Isabel González González, Yolanda Canellas Criado, Silvia Hernández Anadón, Rafael Rotaeche del Campo, Pere Torán Monserrat, Antonio Negrete Palma, Guillem Pera, Eulàlia Borrell Thió, Carl Llor, Paul Little, Pablo Alonso Coello, Delayed Antibiotic Prescription (DAP) Working Group, Pablo Alonso-Coello, José Martínez Zapata, Gerard Urrutia Cuchí, Lorena Martínez Villamar, Ignasi Gich, Gemma Mas Dalmau, Mariam De la Poza Abad, Mercedes Liroz Navarro, Eulàlia Borrell Thió, Núria Barrera Aguilera, Maite Coll Perona, Asumpta Libre Saló, Marta Cañibano Gómez, Silvia Sierra Pujante, Marta Besa Castellà, Marisol Miguel Baquero, Maria Alsina Casalduero, Enric Serras Ricart, Victòria Bertran Fontelles, Pere Torán Monserrat, Antonio Negrete Palma, Roser Vallès Navarro, Rosa Coma Carbó, Maite Aizpurua Pérez, Josep Sorribas López, Guillem Pera, Laura Muñoz Ortiz, Ma del Mar Rodríguez Álvarez, Maria Bernades, Laura Ruipérez Guijarro, Ma Adela Viniegra Domínguez, Pere Josep Simonet Aineto, Carl Llor, Silvia Hernández Anadón, Aitor Alfaro Ormaolea, Ana Moragas Moreno, Mikel Moreno Bakedano, Miguel Ángel Senosiain Zabalegui, Pilar Arroyo Aniés, Carlos Amezqueta Goñi, Rafael Rotaeche del Campo, Naiara Campos Morey, Carmen Escribano Andrés, Ma José Seijas Martínez- Echevarria, Yolanda Canellas Criado, Sagrario Muñoz-Quirós Aliaga, Cristina Belló González, Alberto López García-Franco, Ma del Mar Álvarez Villalba, Juan Carlos Moreno Fernández, Marisol Lorenzo Borda, Carlos Aguilera Collado, José Antonio Pere Pedrol, Blanca Gutiérrez Teira, Francisco Ramón Abellán López

Abstract

Background: Respiratory tract infections are an important burden in primary care and it's known that they are usually self-limited and that antibiotics only alter its course slightly. This together with the alarming increase of bacterial resistance due to increased use of antimicrobials calls for a need to consider strategies to reduce their use. One of these strategies is the delayed prescription of antibiotics.

Methods: Multicentric, parallel, randomised controlled trial comparing four antibiotic prescribing strategies in acute non-complicated respiratory tract infections. We will include acute pharyngitis, rhinosinusitis, acute bronchitis and acute exacerbation of chronic bronchitis or chronic obstructive pulmonary disease (mild to moderate). The therapeutic strategies compared are: immediate antibiotic treatment, no antibiotic treatment, and two delayed antibiotic prescribing (DAP) strategies with structured advice to use a course of antibiotics in case of worsening of symptoms or not improving (prescription given to patient or prescription left at the reception of the primary care centre 3 days after the first medical visit).

Discussion: Delayed antibiotic prescription has been widely used in Anglo-Saxon countries, however, in Southern Europe there has been little research about this topic. The DAP trial wil evaluate two different delayed strategies in Spain for the main respiratory infections in primary care.

Trial registration: This trial is registered with ClinicalTrials.gov, number http://NCT01363531.

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Source: PubMed

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