According to recent research, reducing the number of prescriptions of antibiotics for respiratory tract infections, such as sore throats, colds, coughs, and ear infections, is not associated with an increase in the most serious bacterial complications, like bacterial meningitis.
The study, “Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records,” was published in the journal BMJ.
Concern is growing that the widespread and sometimes unnecessary use of antibiotics is leading to the development of antimicrobial drug resistance and potentially to infections caused by resistant organisms that are difficult to treat.
Reducing the inappropriate use of antibiotics, as well as ensuring that they can be used when needed, represents an important strategy to control infectious diseases.
Researchers set out to determine whether the incidence of pneumonia, peritonsillar abscess, mastoiditis, emphyema, meningitis, intracranial abscess, and Lemierre’s syndrome is higher in general practices that prescribe fewer antibiotics for self-limiting respiratory tract infections (RTIs). So a team led by researchers at King’s College London examined patient records from 610 U.K. general practices (GP) with more than 4 million patients over 10 years.
They found that GPs who adopt a policy to reduce antibiotic prescriptions for RTIs might expect a slight increase in the incidence of treatable pneumonia and peritonsillar abscess, a rare complication of sore throats. The team found that if an average-sized GP practice with 7,000 patients reduced its antibiotic prescriptions for RTIs by 10 percent, there could be one extra pneumonia case every year and one extra case of peritonsillar abscess every 10 years.
The authors noted that a substantial reduction in antibiotic prescribing seemed to be associated with only a small increase in cases observed, but caution might be required in subgroups at a higher risk of pneumonia.
“Overuse of antibiotics now may result in increasing infections by resistant bacteria in the future. Current treatment recommendations are to avoid antibiotics for self-limiting respiratory infections,” Prof. Martin Gulliford, the study’s lead author, from the Division of Health and Social Care Research at King’s College London, said in a news release.
“Our results suggest that, if antibiotics are not taken, this should carry no increased risk of more serious complications. General practices prescribing fewer antibiotics may have slightly higher rates of pneumonia and peritonsillar abscess, but even a substantial reduction in antibiotic prescribing may be associated with only a small increase in the numbers of cases observed. Both these complications can be readily treated once identified.”
Dr. Mark Ashworth, author of the study from the King’s Division of Health and Social Care Research, said that as a practicing general practioner, he sees few complications from patients who have upper respiratory tract infections and who decide against antibiotics to treat their infections.
“Patients are recognizing that most upper respiratory infections are viral and virus infections do not respond to antibiotics,” Ashworth said. “Our paper should reassure GPs and patients that rare bacterial complications of respiratory infections are indeed rare. Fortunately, if there are any signs of a complication, the GP can quickly step in and offer an appropriate antibiotic.”
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