In the Journals

Reducing antibiotics for RTIs yields no increase in bacterial complications

An association between an increase in bacterial complications and a reduction in prescribing antibiotics for respiratory tract infections was considered minimal, according to recent study results.

Martin C. Gulliford

 

“Antibiotic treatment of [respiratory tract infections (RTIs)] offers negligible benefit to affected patients and is often associated with side effects,” Martin C. Gulliford, MD, professor in the department of primary care and public health sciences at King’s College London, and colleagues wrote. “Guidance in the United Kingdom recommends that either a no antibiotic prescribing strategy or a delayed antibiotic prescribing strategy should be agreed for most patients with RTIs. Nevertheless, around 36% of common colds continue to be treated with antibiotics, as do 40% of episodes of sore throat, 70% of otitis media, and 90% of sinusitis.”

The researchers analyzed a cohort of more than 4 million patients from 610 general practices to determine whether the incidence for pneumonia, peritonsillar abscess, mastoiditis, meningitis and other infections increased at general practices that prescribed fewer antibiotics for RTIs.

During the 2005 to 2014 study period, the investigators wrote that the proportion of RTI consultations in which antibiotics were prescribed declined from 53.9% to 50.5% among men and from 54.5% to 51.5% in women. General practices that prescribed fewer antibiotics for RTIs showed no greater incidence rates for bacterial complications, including meningitis, mastoiditis and brain abscess. Gulliford and colleagues wrote that new episodes of meningitis (5.3%), mastoiditis (4.6%) and brain abscess (1%) decreased annually. The adjusted RR increases for a 10% reduction in prescribing antibiotics were 12.8% for pneumonia and 9.9% for peritonsillar abscess (both P < .001).

“If a general practice with an average list size of 7,000 patients reduces the proportion of RTI consultations with antibiotics prescribed by 10%, then it might observe 1.1 more cases of pneumonia each year and 0.9 more cases of peritonsillar abscesses each decade,” the researchers wrote.

Overall, the researchers found that general practices that prescribe fewer antibiotics for RTIs may see these slight increases, but there would be no expected increases in bacterial meningitis, mastoiditis or brain abscess.

“Our results suggest that, if antibiotics are not taken, this should carry no increased risk of more serious complications,” Gulliford said in a press release. – by Kate Sherrer

Disclosure: The researchers report no relevant financial disclosures.

An association between an increase in bacterial complications and a reduction in prescribing antibiotics for respiratory tract infections was considered minimal, according to recent study results.

Martin C. Gulliford

 

“Antibiotic treatment of [respiratory tract infections (RTIs)] offers negligible benefit to affected patients and is often associated with side effects,” Martin C. Gulliford, MD, professor in the department of primary care and public health sciences at King’s College London, and colleagues wrote. “Guidance in the United Kingdom recommends that either a no antibiotic prescribing strategy or a delayed antibiotic prescribing strategy should be agreed for most patients with RTIs. Nevertheless, around 36% of common colds continue to be treated with antibiotics, as do 40% of episodes of sore throat, 70% of otitis media, and 90% of sinusitis.”

The researchers analyzed a cohort of more than 4 million patients from 610 general practices to determine whether the incidence for pneumonia, peritonsillar abscess, mastoiditis, meningitis and other infections increased at general practices that prescribed fewer antibiotics for RTIs.

During the 2005 to 2014 study period, the investigators wrote that the proportion of RTI consultations in which antibiotics were prescribed declined from 53.9% to 50.5% among men and from 54.5% to 51.5% in women. General practices that prescribed fewer antibiotics for RTIs showed no greater incidence rates for bacterial complications, including meningitis, mastoiditis and brain abscess. Gulliford and colleagues wrote that new episodes of meningitis (5.3%), mastoiditis (4.6%) and brain abscess (1%) decreased annually. The adjusted RR increases for a 10% reduction in prescribing antibiotics were 12.8% for pneumonia and 9.9% for peritonsillar abscess (both P < .001).

“If a general practice with an average list size of 7,000 patients reduces the proportion of RTI consultations with antibiotics prescribed by 10%, then it might observe 1.1 more cases of pneumonia each year and 0.9 more cases of peritonsillar abscesses each decade,” the researchers wrote.

Overall, the researchers found that general practices that prescribe fewer antibiotics for RTIs may see these slight increases, but there would be no expected increases in bacterial meningitis, mastoiditis or brain abscess.

“Our results suggest that, if antibiotics are not taken, this should carry no increased risk of more serious complications,” Gulliford said in a press release. – by Kate Sherrer

Disclosure: The researchers report no relevant financial disclosures.