What is the watch and wait approach for antibiotics?

From the Guidelines

Watch and wait for antibiotics is a recommended strategy for certain infections, such as mild ear infections, where delaying antibiotic prescription for 48-72 hours can help reduce unnecessary antibiotic use without worsening clinical outcomes. This approach is supported by recent guidelines, including those from the European Society of Clinical Microbiology and Infectious Diseases 1, which emphasize the importance of antimicrobial stewardship in emergency departments. The watch and wait strategy involves monitoring symptoms while using supportive treatments like rest, fluids, and over-the-counter pain relievers, and prescribing antibiotics only if symptoms worsen or don't improve after the observation period.

Key points to consider when implementing the watch and wait strategy include:

• The importance of proper patient selection, as this approach may not be suitable for severe bacterial infections, infections in very young children or elderly patients, or in people with compromised immune systems
• The need for clear communication with patients and caregivers about the watch and wait approach, including the potential benefits and risks, and the importance of monitoring symptoms and seeking medical attention if they worsen or don't improve
• The use of supportive treatments, such as rest, fluids, and over-the-counter pain relievers, to help manage symptoms during the observation period
• The importance of follow-up and reassessment after the observation period to determine if antibiotic prescription is necessary

A study published in Pediatrics in 2013 1 found that observation as initial management for acute otitis media (AOM) in properly selected children does not increase suppurative complications, provided that follow-up is ensured and a rescue antibiotic is given for persistent or worsening symptoms. The study also found that approximately half of young children experienced clinical success when given placebo, but the effect of antibiotic therapy was substantially greater than suggested by studies without precise diagnosis.

Overall, the watch and wait strategy for antibiotics has the potential to reduce unnecessary antibiotic use and promote antimicrobial stewardship, while also improving patient outcomes and reducing the risk of antibiotic resistance. By implementing this strategy, healthcare providers can help reduce the overuse of antibiotics and promote more responsible use of these important medications.

From the Research

Watch and Wait Approach for Antibiotics

• The watch and wait approach for antibiotics is a strategy where patients with certain conditions, such as urinary tract infections (UTIs), are monitored and only given antibiotics if their symptoms worsen or do not improve 2.
• This approach is often considered for patients with low-risk conditions, such as uncomplicated lower urinary tract infections, to reduce the overuse of antibiotics and prevent antibiotic resistance 3, 4.
• Studies have shown that patients who choose watchful waiting or active surveillance as an approach to medical treatment experience a range of emotions, including uncertainty, anxiety, and fear, and require empathic and reassuring relationships with healthcare practitioners 2.

Antibiotic Resistance and Treatment Options

• Antibiotic resistance is a growing concern, particularly in low- and middle-income countries, where access to effective antibiotics is limited 5.
• High rates of resistance have been reported for commonly used antibiotics, such as trimethoprim-sulfamethoxazole, ampicillin, and fluoroquinolones, making treatment of UTIs challenging 4, 5.
• Alternative treatment options, such as nitrofurantoin, fosfomycin, and pivmecillinam, have been recommended for uncomplicated UTIs, while more severe cases may require parenteral treatment with carbapenems or other broad-spectrum antibiotics 4.

Patient Compliance and Efficacy

• Patient compliance with antibiotic treatment is crucial for effective treatment of UTIs, and studies have shown that simpler treatment regimens, such as once-daily dosing, can improve compliance 6.
• The efficacy of different antibiotics in treating UTIs has been compared in several studies, with trimethoprim-sulfamethoxazole and nitrofurantoin being effective options for uncomplicated lower urinary tract infections 3, 6.