Antibiotics Are Not Successful In Treating Severe Coughs
A European study confirms that doctors should restrict the use of antibiotics for lower respiratory infections.
--by Suzanne Boothby
study so far examining the use of antibiotics to treat lower respiratory
tract infections has confirmed they are ineffective, even for patients
60 years and older.
These types of infections are more serious than upper respiratory infections, and are often characterized by extended coughs, shortness of breath, high fever, and fatigue. While many people with these symptoms develop pneumonia, it can also be a sign of acute bronchitis or a lung abscess.
Lower respiratory tract infections are one of the most common acute illnesses managed in doctors’ offices. The medical consensus has been to limit antibiotic use, but some debate remained for especially vulnerable groups, such as seniors.
In the new study, published in the British journal The Lancet, the antibiotic amoxicillin did not significantly affect the duration of symptoms in the first few days of infection in any of the age groups studied, compared to a placebo. Symptom severity also did not differ significantly between treatment groups.
Amoxicillin did prevent some patients from developing new or worse symptoms, but the amount required was high and did not outweigh the harmful side-effects at that dosage level. The researchers concluded that unless pneumonia is suspected, antibiotics should not be prescribed to any patients with acute lower respiratory tract infections.
The Expert Take
“Patients given amoxicillin don't recover much quicker or have significantly fewer symptoms,” said lead researcher Paul Little from the University of Southampton in the U.K. “Our results show that most people get better on their own. But, given that a small number of patients will benefit from antibiotics, the challenge remains to identify these individuals.”
Antibiotic overuse and resistance is a growing public health problem, as germs develop ways to outsmart drugs and cause further health complications.
“Overuse of antibiotics (which is dominated by primary care prescribing), particularly when they are ineffective, can lead to side effects (e.g., diarrhea, rash, vomiting) and the development of resistance,” Little said.
In healthcare and community settings, reports reveal that germs are stronger than any antibiotics we have to treat them, according to the Centers for Disease Control and Prevention (CDC).
“We're finding that the widespread overuse—as well as inappropriate use—of antibiotics is fueling antibiotic resistance,” the CDC website said.
According to the CDC, antibiotics cure bacterial infections, not viral infections, such as colds or the flu, most coughs and bronchitis, sore throats not caused by strep bacteria, and runny noses.
Dr. Bob Harrison, a noted epidemiologist and infectious disease consultant at Children’s Healthcare of Atlanta is famously quoted as saying, “The major reason we are seeing antibiotic resistance is overuse of antibiotics in the population for illnesses that don't require antibiotics—typically colds, sore throats, quote bronchitis unquote—illnesses that would resolve by themselves because they are caused by viruses.”
Source and Method
The study was a parallel, randomized, placebo-controlled trial. It involved more than 2,000 adults with acute uncomplicated lower respiratory tract infections from primary care practices in 12 European countries who were randomly assigned to receive either amoxicillin or a placebo three times a day for seven days. Doctors assessed their symptoms at the start of the study, and participants completed a daily symptom diary.
The two groups reported very little difference in the severity or duration of their symptoms. Patients taking antibiotics reported significantly more side-effects, including nausea, rash, and diarrhea, than those given the placebo. Only two patients in the placebo group and one in the antibiotic group required hospitalization. The researchers found no evidence of selective benefit in patients ages 60 years or older.
Unless a doctor suspects that a patient has pneumonia, amoxicillin provides little benefit for acute lower respiratory tract infection both overall and in patients ages 60 years and older.
"Little and colleagues have generated convincing data that should encourage physicians in primary care to refrain from antibiotic treatment in low-risk patients in whom pneumonia is not suspected,” said Philipp Schuetz from the Kantonsspital Aarau in Switzerland. “Whether this one-size-fits-all approach can be further improved remains to be seen. Guidance from measurements of specific blood biomarkers of bacterial infection might help to identify the few individuals who will benefit from antibiotics despite the apparent absence of pneumonia and avoid the toxic effects and costs of those drugs and the development of resistance in other patients.”
A 2006 Belgian study found that patient demand had a significant and clinically relevant effect on whether doctors prescribed antibiotic use for acute cough, and recommended further guidelines for antibiotic prescription.