Delayed antibiotic prescribing for respiratory tract infections: protocol of an individual patient data meta-analysis

Beth Stuart, Hilda Hounkpatin, Taeko Becque, Guiqing Yao, Shihua Zhu, Pablo Alonso-Coello, Attila Altiner, Bruce Arroll, Dankmar Bohning, Jennifer Bostock, Heiner C Bucher, Mariam de la Poza, Nick A Francis, David Gillespie, Alastair Hay, Timothy Kenealy, Christin Loffler, Gemma Mas-Dalmau, Laura Munoz, Kirsty SamuelMichael Moore, Paul Little

Research output: Contribution to journalArticle (Academic Journal)peer-review

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INTRODUCTION: Delayed prescribing can be a useful strategy to reduce antibiotic prescribing, but it is not clear for whom delayed prescribing might be effective. This protocol outlines an individual patient data (IPD) meta-analysis of randomised controlled trials (RCTs) and observational cohort studies to explore the overall effect of delayed prescribing and identify key patient characteristics that are associated with efficacy of delayed prescribing.

METHODS AND ANALYSIS: A systematic search of the databases Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid Embase, EBSCO CINAHL Plus and Web of Science was conducted to identify relevant studies from inception to October 2017. Outcomes of interest include duration of illness, severity of illness, complication, reconsultation and patient satisfaction. Study authors of eligible papers will be contacted and invited to contribute raw IPD data. IPD data will be checked against published data, harmonised and aggregated to create one large IPD database. Multilevel regression will be performed to explore interaction effects between treatment allocation and patient characteristics. The economic evaluation will be conducted based on IPD from the combined trial and observational studies to estimate the differences in costs and effectiveness for delayed prescribing compared with normal practice. A decision model will be developed to assess potential savings and cost-effectiveness in terms of reduced antibiotic usage of delayed prescribing and quality-adjusted life years.

ETHICS AND DISSEMINATION: Ethical approval was obtained from the University of Southampton Faculty of Medicine Research Ethics Committee (Reference number: 30068). Findings of this study will be published in peer-reviewed academic journals as well as General Practice trade journals and will be presented at national and international conferences. The results will have important public health implications, shaping the way in which antibiotics are prescribed in the future and to whom delayed prescriptions are issued.


Original languageEnglish
Article numbere026925
Number of pages7
JournalBMJ Open
Issue number1
Early online date21 Jan 2019
Publication statusPublished - Jan 2019


  • general medicine
  • health economics
  • respiratory medicine
  • statistics and research methods


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