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Antibiotics Are Rarely Indicated for Respiratory Tract Infections

But elderly patients at risk for pneumonia might benefit.

Concern for antibiotic resistance remains high, yet antibiotics can prevent severe infections in selected cases. Researchers retrospectively analyzed data from 3.36 million episodes of respiratory tract infection entered into the U.K. General Practice Research Database during 10 years to assess the effect of antibiotic use on rates of serious complications.

Among more than 1 million episodes each of upper respiratory tract infection and sore throat and nearly half a million cases of otitis media, the risk for serious complications (pneumonia, peritonsillar abscess, and mastoiditis, respectively) during the month after diagnosis was low in patients who were not prescribed antibiotics. This risk was reduced significantly with antibiotics, but the number needed to treat to prevent one serious complication was more than 4000.

Among nearly 750,000 episodes of patients presenting with symptoms suggesting chest infection, the risk for pneumonia was significantly higher than that with upper respiratory tract infection and was lowered significantly with antibiotics, especially in patients aged 65 or older (from 4.0% without antibiotics to 1.5% with). The number needed to treat to prevent one case of pneumonia was 39 in this age group and ranged from 96 to 119 in younger age groups. Adjusting for smoking status and underlying chronic respiratory disease did not alter the data.

An editorial reminds us that acute rheumatic fever and acute glomerulonephritis are now rare in industrialized countries and vanishingly rare in adults, so prescribing antibiotics for suspected strep throat is less important than it was in the past.

Comment: Even though patients with more-severe disease would be more likely to receive antibiotics in this study, still, almost no antibiotic benefit was demonstrated. As physicians, we need to end our love affair with antibiotics for respiratory infection, reserving them for patients who really have the potential for benefit — that is, elderly patients with suspected lower respiratory tract infection, in whom pneumonia can carry significant morbidity and mortality.

— Kristi L. Koenig, MD, FACEP

Published in Journal Watch Emergency Medicine December 14, 2007

Citation(s):

Petersen I et al. Protective effect of antibiotics against serious complications of common respiratory tract infections: Retrospective cohort study with the UK General Practice Research Database. BMJ 2007 Nov 10; 335:982.

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• Medline abstract (Free)

Coenen S and Goossens H. Antibiotics for respiratory tract infections in primary care. BMJ 2007 Nov 10; 335:946.

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• Medline abstract (Free)