Non-Antibiotic Prescribing for Respiratory Infections Poses No Safety Risk

Retail clinics could help slow the development of dangerous antibiotic-resistant bacteria by prescribing fewer antibiotics for respiratory tract infections, recent study results published inBMJsuggest.

The authors of the study noted that most cases of respiratory infection—including colds, coughs, sore throats, and ear infections—are viral in origin and resolve without antibiotic treatment.

Their retrospective study looked for connections between general practitioners’ (GP) rates of antibiotic prescribing for respiratory infection and incidence of serious bacterial complications, such as brain abscess, Lemierre’s syndrome, empyema, mastoiditis, or meningitis. Data were drawn from more than 4 million patient records across 610 general practices in the United Kingdom over a 10-year period.

Researchers found that practices with a lower rate of antibiotic use for respiratory infection did not have higher rates of any of the serious complications listed above. They did, however, observe a slightly higher incidence of pneumonia and peritonsillar abscess (quinsy), a rare complication related to sore throat and tonsillitis. Still, those 2 conditions are easily treatable with antibiotics once identified, lead study author Martin Gulliford, of King’s College’s Division of Health and Social Care Research, and his colleagues pointed out.

They reasoned that the slightly increased risk of bacterial complication is a fair tradeoff for preserving the effectiveness of antibiotic therapies for the general population and for avoiding unnecessary side effects.

The authors estimated that a 10% reduction in antibiotic prescriptions for respiratory infection in an average-sized UK practice treating 7000 patients would result in 1 additional case of pneumonia per year, and only 1 additional case of quinsy every 10 years. However, they cautioned that their findings represent averages across a general UK population, rather than potential outcomes for an individual patient.

Co-author Dr. Mark Ashworth commented that, in his practice, “Patients are recognizing that most upper respiratory infections are viral and virus infections do not respond to antibiotics.”

“Our paper should reassure [health care providers] and patients that rare bacterial complications of respiratory infections are indeed rare,” he continued. “Fortunately, if there are any signs of a complication, [providers] can quickly step in and offer an appropriate antibiotic.”

Although rare, clinicians should still remain wary of symptoms of bacterial complications. For pneumonia, symptoms may include chest pain, persistent fever, difficulty breathing, or persistent cough. For peritonsillar abscess, symptoms may include a severe and worsening sore throat, swelling, earache, headache, or difficulty swallowing or breathing.

About 30% of alloutpatient oral antibiotic prescriptionswritten in the United States are inappropriate, results of a recent CDC study suggested.

“Half of antibiotic prescriptions for acute respiratory conditions may have been unnecessary, representing 34 million antibiotic prescriptions annually,” the researchers wrote.