BACKGROUND Delayed (or "backup") antibiotic prescription, where the patient is given a prescription but advised to delay initiating antibiotics, has been shown to be effective in reducing antibiotic use in primary care. However, this strategy is not widely used in the United Kingdom. This study aimed to identify factors influencing preferences among the UK public for delayed prescription, and understand their relative importance, to help increase appropriate use of this prescribing option. METHODS AND FINDINGS We conducted an online choice experiment in 2 UK general population samples: adults and parents of children under 18 years. Respondents were presented with 12 scenarios in which they, or their child, might need antibiotics for a respiratory tract infection (RTI) and asked to choose either an immediate or a delayed prescription. Scenarios were described by 7 attributes. Data were collected between November 2018 and February 2019. Respondent preferences were modelled using mixed-effects logistic regression. The survey was completed by 802 adults and 801 parents (75% of those who opened the survey). The samples reflected the UK population in age, sex, ethnicity, and country of residence. The most important determinant of respondent choice was symptom severity, especially for cough-related symptoms. In the adult sample, the probability of choosing delayed prescription was 0.53 (95% confidence interval (CI) 0.50 to 0.56, p < 0.001) for a chesty cough and runny nose compared to 0.30 (0.28 to 0.33, p < 0.001) for a chesty cough with fever, 0.47 (0.44 to 0.50, p < 0.001) for sore throat with swollen glands, and 0.37 (0.34 to 0.39, p < 0.001) for sore throat, swollen glands, and fever. Respondents were less likely to choose delayed prescription with increasing duration of illness (odds ratio (OR) 0.94 (0.92 to 0.96, p < 0.001)). Probabilities of choosing delayed prescription were similar for parents considering treatment for a child (44% of choices versus 42% for adults, p = 0.04). However, parents differed from the adult sample in showing a more marked reduction in choice of the delayed prescription with increasing duration of illness (OR 0.83 (0.80 to 0.87) versus 0.94 (0.92 to 0.96) for adults, p for heterogeneity p < 0.001) and a smaller effect of disruption of usual activities (OR 0.96 (0.95 to 0.97) versus 0.93 (0.92 to 0.94) for adults, p for heterogeneity p < 0.001). Females were more likely to choose a delayed prescription than males for minor symptoms, particularly minor cough (probability 0.62 (0.58 to 0.66, p < 0.001) for females and 0.45 (0.41 to 0.48, p < 0.001) for males). Older people, those with a good understanding of antibiotics, and those who had not used antibiotics recently showed similar patterns of preferences. Study limitations include its hypothetical nature, which may not reflect real-life behaviour; the absence of a "no prescription" option; and the possibility that study respondents may not represent the views of population groups who are typically underrepresented in online surveys. CONCLUSIONS This study found that delayed prescription appears to be an acceptable approach to reducing antibiotic consumption. Certain groups appear to be more amenable to delayed prescription, suggesting particular opportunities for increased use of this strategy. Prescribing choices for sore throat may need additional explanation to ensure patient acceptance, and parents in particular may benefit from reassurance about the usual duration of these illnesses.

中文翻译：

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英国初级保健中延迟或立即抗生素处方的公众偏好：选择实验。

背景延迟（或“备用”）抗生素处方，即给患者开处方但建议延迟开始抗生素，已被证明可有效减少初级保健中的抗生素使用。然而，这种策略在英国并没有被广泛使用。本研究旨在确定影响英国公众对延迟处方偏好的因素，并了解它们的相对重要性，以帮助增加对这种处方选择的适当使用。方法和结果 我们在 2 个英国一般人群样本中进行了在线选择实验：成人和 18 岁以下儿童的父母。受访者面临 12 种情况，在这些情况下，他们或他们的孩子可能需要抗生素治疗呼吸道感染 (RTI)，并要求他们选择立即开药或延迟开药。情景由 7 个属性描述。数据收集于 2018 年 11 月至 2019 年 2 月之间。受访者偏好使用混合效应逻辑回归建模。该调查由 802 名成年人和 801 名家长（占参与调查者的 75%）完成。样本反映了英国人口的年龄、性别、种族和居住国。受访者选择的最重要决定因素是症状严重程度，尤其是咳嗽相关症状。在成人样本中，咳嗽和流鼻涕的选择延迟处方的概率为 0.53（95% 置信区间 (CI) 0.50 至 0.56，p < 0.001），而咳嗽和流鼻涕的概率为 0.30（0.28 至 0.33，p < 0.001）伴有发热的胸闷咳嗽，对于腺体肿胀的喉咙痛为 0.47（0.44 至 0.50，p < 0.001），对于喉咙痛为 0.37（0.34 至 0.39，p < 0.001），腺体肿胀，发烧。随着疾病持续时间的增加，受访者不太可能选择延迟处方（优势比 (OR) 0.94（0.92 至 0.96，p < 0.001））。考虑为孩子治疗的父母选择延迟处方的概率相似（选择的 44% 对成人的 42%，p = 0.04）。然而，父母与成人样本的不同之处在于，随着疾病持续时间的增加，延迟处方的选择更显着减少（成人的 OR 0.83（0.80 至 0.87）与 0.94（0.92 至 0.96），异质性 p < 0.001）日常活动中断的影响较小（成人的 OR 0.96（0.95 至 0.97）与 0.93（0.92 至 0.94），异质性 p < 0.001）。对于轻微症状，女性比男性更可能选择延迟处方，特别轻微的咳嗽（女性的概率为 0.62（0.58 至 0.66，p < 0.001），男性的概率为 0.45（0.41 至 0.48，p < 0.001））。老年人、对抗生素有很好了解的人和最近没有使用过抗生素的人表现出相似的偏好模式。研究局限性包括其假设性质，可能无法反映现实生活中的行为；没有“无处方”选项；以及研究受访者可能不代表在线调查中代表性不足的人群的观点的可能性。结论 本研究发现，延迟处方似乎是减少抗生素消耗的可接受方法。某些群体似乎更愿意延迟处方，这表明增加使用这种策略的特殊机会。