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18-12-2012 | General practice | Article

No support for LRTI antibiotics

Abstract

Lancet Infect Dis 2012; Advance online publication

Antibiotic treatment for uncomplicated, lower respiratory tract infection (LRTI) has little impact on the severity or duration of symptoms, shows the largest placebo-controlled trial to date.

In the multicentre, European study, 2061 adults with LRTI and no suspected pneumonia were randomly assigned to receive amoxicillin or placebo for 7 days.

The authors found that patients in the amoxicillin group were 21% less likely to develop new or worsening symptoms than those in the placebo group (15.9 vs 19.3%). However, the number needed to treat to prevent one patient from deteriorating was high at 30.

Furthermore, while there was no significant difference in the severity or duration of symptoms between the groups, 28.5% of patients in the amoxicillin group reported nausea, rash or diaorrhea, compared with 24.0% in the placebo group.

The authors say in Lancet Infectious Diseases that their findings indicate that the benefits of antibiotic treatment for LRTI are unlikely to balance against the harms. "Our results show that most people get better on their own," said Professor Paul Little, from the University of Southampton, in a press statement.

However, they caution that because their sample included otherwise healthy patients and no elderly people with multiple comorbidities, the findings cannot be extrapolated to all patient groups. "Given that a small number of patients will benefit from antibiotics the challenge remains to identify these individuals," Little stated.

In an accompanying editorial, Philipp Schuetz (Kantonsspital Aarau, Switzerland) says the findings should give GPs confidence in reducing antibiotic prescriptions: "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."

Medical News is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Kirsty Oswald