European trial confirms commonly prescribed antibiotic ineffective for treating cough

December 18, 2012

The antibiotic amoxicillin, that doctors typically prescribe for common lower respiratory tract infections (LRTI) such as cough and bronchitis, is no more effective at relieving symptoms than the use of no medication, even in older patients. The findings from the largest randomised placebo controlled trial of antibiotics for acute uncomplicated LRTI to date are published Online First in The Lancet Infectious Diseases.

"Patients given don't recover much quicker or have significantly fewer symptoms", explains Paul Little from the University of Southampton in the UK who led the research. "Using amoxicillin to treat respiratory infections in patients not suspected of having pneumonia is not likely to help and could be harmful. (which is dominated by primary care prescribing), particularly when they are ineffective, can lead to side effects (eg, diarrhoea, rash, vomiting) and the development of resistance."

A cough that is accompanied by symptoms is one of the most common acute illnesses treated in primary care. Although viruses are believed to cause most of these infections, whether or not antibiotics are beneficial in the treatment of LRTI, particularly in older patients, is still hotly debated. Research so far has produced conflicting results.

In this study, 2061 adults with acute uncomplicated LRTI from primary care practices in 12 European countries (England, Wales, Netherlands, Belgium, Germany, Sweden, France, Italy, Spain, Poland, Slovenia, and Slovakia) were randomly assigned to receive either amoxicillin or a placebo three times a day for 7 days. Doctors assessed symptoms at the start of the study and participants completed a daily symptom diary.

Little difference in severity or duration of symptoms was reported between the two groups. This was true even for older patients (aged 60 or more) who were generally healthy, in whom antibiotics appeared to have a very limited effect.

Although significantly more patients in the placebo group experienced new or worsening symptoms (19.3% vs 15.9%), the number of people that needed to be treated to prevent one case of worsening symptoms was high (30), and just two patients in the placebo group and one in the antibiotic group required hospitalisation.

What is more, patients taking antibiotics reported significantly more side effects including nausea, rash, and , than those given placebo (28.7% vs 24%).

According to Little, "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."

Writing in a linked Comment, Philipp Schuetz from the Kantonsspital Aarau in Switzerland says, "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. 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."

More information: www.thelancet.com/journals/lancetid/article/PIIS1473-3099(12)70300-6/abstract

Related Stories

Study: Antibiotics ineffective for most sinus infections

February 14, 2012

Antibiotics that doctors typically prescribe for sinus infections do not reduce symptoms any better than an inactive placebo, according to investigators at Washington University School of Medicine in St. Louis.

Recommended for you

Experimental MERS vaccine shows promise in animal studies

July 28, 2015

A two-step regimen of experimental vaccines against Middle East respiratory syndrome (MERS) prompted immune responses in mice and rhesus macaques, report National Institutes of Health scientists who designed the vaccines. ...

Can social isolation fuel epidemics?

July 21, 2015

Conventional wisdom has it that the more people stay within their own social groups and avoid others, the less likely it is small disease outbreaks turn into full-blown epidemics. But the conventional wisdom is wrong, according ...

Lack of knowledge on animal disease leaves humans at risk

July 20, 2015

Researchers from the University of Sydney have painted the most detailed picture to date of major infectious diseases shared between wildlife and livestock, and found a huge gap in knowledge about diseases which could spread ...

IBD genetically similar in Europeans and non-Europeans

July 20, 2015

The first genetic study of inflammatory bowel disease (IBD) to include individuals from diverse populations has shown that the regions of the genome underlying the disease are consistent around the world. This study, conducted ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.