Information about the natural history of acute infections commonly seen in primary care: a systematic review of clinical practice guidelines

Objectives: To examine the reporting of natural history information, and relevant antibiotic stewardship strategies, in clinical guidelines for acute infections commonly seen in primary care and sometimes managed with antibiotics.MethodsA systematic review of national and international guidelines (2010 onwards), electronically available, for managing acute infections (respiratory, urinary, or skin and soft tissue). We searched MEDLINE, CINAHL, EMBASE, TRIP, and GIN databases and websites of 22 guideline-publishing organisations.ResultsWe identified 82 guidelines, covering 114 eligible infections. Natural history information was reported in 49 (59.8%) of the guidelines and 66 (57.9%) of the conditions, most commonly for respiratory tract infections. Quantitative information about the expected infection duration was provided for 63.5% (n = 42) of the infections. Delayed prescribing was recommended for 34.2% (n = 39) of them and shared decision making for 21% (n = 24).ConclusionsJust over half of the guidelines for acute infections that are commonly managed in primary care and often with antibiotics contained natural history information. As many of these infections spontaneously improve, this is a missed opportunity to disseminate this information to clinicians, promote antibiotic stewardship, and facilitate conversations with patients and informed decision-making. Systematic review registration: CRD42021247048