Delayed Prescribing Strategy
Delayed prescribing reduces antibiotic use by 50-65% with minimal impact on clinical outcomes. Provide the prescription but advise the patient to fill it only if symptoms do not improve within the specified timeframe.
Watchful waiting is appropriate when ALL of the following are met:
- Provide adequate analgesia (ibuprofen/paracetamol at regular intervals)
- Give delayed prescription with clear instructions
- Arrange follow-up or safety-net phone call at 48-72 hours
- Document shared decision-making discussion
- Evidence: 65% of children recover without antibiotics (Arch Pediatr Adolesc Med 2005)
Use these phrases when discussing the management plan with your patient or their caregiver:
"Your child has an ear infection. Most ear infections get better on their own without antibiotics."
"We'll give you a prescription to keep 'just in case' — only use it if your child isn't improving after 2-3 days."
"Give regular pain medicine (ibuprofen or paracetamol) — this is the most important treatment right now."
"Antibiotics can cause tummy upsets and diarrhea, so we want to avoid them if we can."
"About 2 out of 3 children with ear infections recover without needing antibiotics."
"Come back or call us if: fever gets higher, pain gets much worse, you see fluid draining from the ear, or your child seems very unwell."
Evidence Sources:
- JAMA 2006;296(10):1235
- Arch Pediatr Adolesc Med 2005;159(7):679