Antibiotic resistance is a major problem in healthcare. It is important to develop the most effective antibiotic prescription strategy. A recent study investigated the effectiveness of antibiotics in patients with acute uncomplicated respiratory tract infections.
Acute respiratory tract infections are one of the most common complications managed by primary care physicians. These patients most commonly present with a new or worsening cough, and may be prescribed antibiotics. Whether the administration of antibiotics help reduce the risk of additional and recurrent complications is unclear and actively debated. Some argue that the use of antibiotics could not only be ineffective but also quite dangerous by promoting antibiotic resistance. In contrast, others tend to prescribe antibiotics to avoid potential long-term complications with medical and/or legal consequences.
A recent study published in The British Medical Journal (BMJ) investigated whether antibiotic administration should be recommended for patients with acute respiratory tract infections. The study included a total of 28,779 patients, with acute uncomplicated respiratory tract infection, from 522 general practices between October 2009 and April 2013. Of these, 25.5% weren’t administered antibiotics, 61.3% were immediately given antibiotics, while the remainder were given antibiotics after a delay period. Patients were then followed over a 30-day period to measure primary outcomes including a re-consultation with the primary care physician, a visit to the emergency department, a hospital admission, or death.
The study found that immediate administration of antibiotics was not significantly associated with a reduction in hospital admissions or death. More specifically, hospital admission or death occurred in 0.3% of the patients given no antibiotics, in 0.9% of patients given antibiotics immediately, and in 0.4% in patients given antibiotics after a delay. Additionally, the authors found that a delayed administration of antibiotics resulted in fewer occurrences of re-consultation, in comparison to immediate administration of antibiotics.
In conclusion, the study confirmed that immediate administration of antibiotics for patients with acute uncomplicated respiratory tract infections is not effective in reducing hospital admission, re-consultation, or death. Rather, a delayed administration of antibiotics is more appropriate. It is understandable that medical doctors want to reduce long-term complications and avoid legal consequences of not prescribing antibiotics. With that being said, the current study shows that perhaps the use of antibiotics, at least immediately, could actually prove to be more harmful to the patients. Moving forward, more thorough research is needed to understand the mechanisms behind why a delayed approach is more effective. Additionally, a larger cohort should be used to validate the current study’s findings.
Written by Haisam Shah, BSc
Little, P., Stuart, B., Smith, S., Thompson, M. J., Knox, K., van den Bruel, A., … & Mant, D. (2017). Antibiotic prescription strategies and adverse outcome for uncomplicated lower respiratory tract infections: prospective cough complication cohort (3C) study. BMJ, 357, j2148.