PT  - JOURNAL ARTICLE
AU  - Beth Stuart
AU  - Hilda Hounkpatin
AU  - Taeko Becque
AU  - Guiqing Yao
AU  - Shihua Zhu
AU  - Pablo Alonso-Coello
AU  - Attila Altiner
AU  - Bruce Arroll
AU  - Dankmar Böhning
AU  - Jennifer Bostock
AU  - Heiner C C Bucher
AU  - Mariam de la Poza
AU  - Nick A Francis
AU  - David Gillespie
AU  - Alastair D Hay
AU  - Timothy Kenealy
AU  - Christin Löffler
AU  - Gemma Mas-Dalmau
AU  - Laura Muñoz
AU  - Kirsty Samuel
AU  - Michael Moore
AU  - Paul Little
TI  - Delayed antibiotic prescribing for respiratory tract infections: protocol of an individual patient data meta-analysis
AID  - 10.1136/bmjopen-2018-026925
DP  - 2019 Jan 01
TA  - BMJ Open
PG  - e026925
VI  - 9
IP  - 1
4099  - http://bmjopen.bmj.com/content/9/1/e026925.short
4100  - http://bmjopen.bmj.com/content/9/1/e026925.full
SO  - BMJ Open2019 Jan 01; 9
AB  - 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.PROSPERO registration number CRD42018079400.