Why use back-up/delayed antibiotic prescriptions?

How can back-up/delayed prescriptions help you?

Back-up/delayed antibiotic prescriptions may be helpful (instead of an immediate antibiotic prescription) when:

  • You are uncertain about how an infection might progress.
  • The patient remains concerned about illness progression and is requesting antibiotics despite discussing antibiotics.
  • You are concerned that the patient may need antibiotics when they will have limited access to medical care.


Evidence of benefits

Research evidence from UK-based studies [29-31] and a Cochrane systematic review [32] has shown that using back-up/delayed antibiotic prescriptions (instead of immediate antibiotic prescriptions) with a good explanation is a safe and effective strategy for managing common respiratory tract infections to:

  • Reduce re-consultations more effectively than immediate antibiotic prescriptions, saving both patient and practice time.
  • Prevent complications as effectively as immediate antibiotic prescriptions.
  • Reduce antibiotic use as only 33% - 39% of patients use antibiotics when given a back-up/delayed prescription.
  • Increase patients' ability to self-manage their infection (​​​​​​​​​​​patients report no significant worsening in the duration of illness or experience of pain).
  • Reduce future consultations for similar illnesses.


Common questions and concerns

Some prescribers may be concerned about increasing their use of back-up/delayed prescriptions and have questions:

  • "How long does it take to explain?"

Using the examples provided it takes less than a minute to explain a back-up/delayed prescription.

  • "Will this give a mixed message to patients about whether antibiotics are beneficial?"

Using the examples provided you can explain to patients that they are allowing time for their immune system to fight the infection and only using antibiotics if symptoms get worse or do not improve.

  • "Will patients know how long they should wait before starting antibiotics?"

It is most useful for patients if you can specify the number of days that they should wait before using the antibiotics, rather than saying "a few days".

  • "Will patients just take the antibiotics straight away?"

Research has shown that when a back-up/delayed prescription is explained well, patients use antibiotics approximately 30% of the time.


Providing a good explanation of a back-up/delayed antibiotic prescription to patients will help to address these concerns.

If you are certain that the patient does not need antibiotics, you can discuss antibiotics using the right words to provide a good explanation and reassurance on why antibiotics are not necessary.

You can remind patients to return any unused medicines to a pharmacy for safe disposal.


What do others say about using back-up/delayed antibiotic prescriptions?

Below are two (2 minute) videos of Prof. Paul Little (GP & Professor of Primary Care) using the DESCARTE study [26] to explain the benefits of back-up/delayed antibiotic prescriptions. These videos are from a free online course "TARGET Antibiotics - Prescribing in Primary Care" which you can sign up to here.