Mas‐Dalmau 2021.

Study characteristics
Methods	Randomised controlled trial
Participants	436 children aged 2 to 14 years with uncomplicated respiratory infections (pharyngititis, rhinosinusitis, acute bronchitis, acute otitis media) who attended, with their parent(s), 39 primary care pediatrician's offices in Spain 146 children were randomised to delayed antibiotics, 148 to immediate antibiotics and 142 to no antibiotics. Age: the mean age of participants in the delayed antibiotic group was 6.4 years (SD 3.2); the immediate antibotic group was 6.4 years (SD 3.1); and the no antibiotic group was 6.1 years (SD 6.1). Sex: 68 of the 146 children in the delayed antibiotic group were female; 79 of the 148 children in the immediate antibotic group were female; and 79 of the 142 children in the no antibiotic group were female. Exclusion criteria: AOM: otoscopy with isolated tympanum erythema plus isolated crying, history of fever (low likelihood of otitis diagnosis); history suggestive of serous otitis or chronic suppurative otitis media; serious chronic disease, such as cystic fibrosis or valve heart disease; high fever with crying and severe earache; bilateral involvement; purulent otorrhea; previous complications (septic complications, hearing disturbances); antibiotic intake the previous 2 weeks; symptoms lasting ≥ 4 days; and poor general health status (high fever, hypotonic, somnolence, no response to antipyretic).  Rhinosinusitis: clinical presentation for < 1 week, antibiotic intake in the previous 2 weeks, and using C‐reactive protein quick tests during the visits. Pharyngitis: other causes of sore throat such as ulcers, aphthous ulcer, or thrush; no presence or presence of 1 or 4 Centor criteria, antibiotic intake in the previous 2 weeks, a history of rheumatic fever, a history of peritonsillar abscess, recurrent pharyngotonsillitis (> 5 episodes in the previous year), and using quick antigenic techniques during the visit. Acute bronchitis: children < 3 years old; suspected pneumonia (crepitant, tubular breath sound, unilateral asymmetric hypophonesis, tachypnea, vomiting, severe diarrhea); high fever (axillary temperature > 38.5°C); vomiting and/or severe diarrhea; bronchial asthma; other acute or chronic lung diseases including cystic frosis; active heart disease; psychiatric diagnoses; antibiotic intake in the previous 2 weeks; and using C‐reactive protein quick tests during the visit.
Interventions	Delayed antibiotics prescription (immediate antibiotic prescription, no antibiotic prescription)
Outcomes
Notes