The use of antibiotics did not appear to have any positive measurable effect on the duration or severity of the cough even if the patient had a bacterial respiratory infection. This was shown in a large prospective study of patients who sought treatment for lower respiratory tract infections in US primary care or emergency departments. The study, conducted by researchers at Georgetown University Medical Center and colleagues from the University of Georgia and the University of Wisconsin-Madison, was just published in the Journal of General Internal Medicine.
“Easy” administration of antibiotics
“Upper respiratory infections commonly include the common cold, sinusitis, and ear infections, and there are proven ways to determine whether antibiotics should be administered in any given case,” said lead study author Dan Merenstein, professor of family medicine at the School of Medicine. of Georgetown University. The professor added that “lower respiratory tract infections tend to be more dangerous, as 3%-5% of patients with such infections develop pneumonia. However, given that in many cases it is not possible to perform a chest x-ray to confirm the severity of the infection, doctors prescribe antibiotics to patients without any other indication other than a cough for the existence of a bacterial infection. In addition, patients are used to taking antibiotics for coughs, even if they do not
assist. Basic symptom relief medications combined with time lead to recovery from lower respiratory tract infections in most cases.”
No positive effect
Antibiotics given in the study for lower respiratory tract infections were the appropriate and widely prescribed antibiotics for the treatment of bacterial infections. However, the researchers’ analysis showed that of the 29% of patients whose doctor prescribed an antibiotic at their first visit, there was no positive effect on cough duration or severity compared to patients who did not receive antibiotic treatment.
Overestimation of bacterial infections
“Physicians probably overestimate the proportion of lower respiratory tract infections that are bacterial in nature. At the same time, they overestimate their ability to distinguish viral from bacterial infections,” noted Mark Ebel, a professor at the University of Georgia College of Public Health and one of the authors of the new study. Professor Ebel added that “in our analysis 29% of participants received an antibiotic while 7% received an antiviral drug. However, most patients do not need antiviral medication as there are only two respiratory viruses for which antiviral treatment is available: influenza and the SARS-COV-2 virus that caused the COVID-19 pandemic. There is no anti-virus for any other virus.”
Thorough laboratory control
In order to determine whether the patients had a bacterial or viral infection – in addition to their own self-report of the cough symptom – the researchers confirmed the presence of pathogens by applying advanced laboratory tests.
They looked for either only bacteria, or only viruses, or viruses in combination with bacteria, or the case where there is no micro-organism and the sample is clean.
Same duration of illness
As it turned out, in cases of confirmed bacterial infection, the duration of illness until recovery was the same between patients who received an antibiotic and patients who did not – about 17 days.
The consequences of antibiotic abuse are serious
Antibiotic abuse can lead to dizziness, nausea, diarrhea and rash while a 4% rate of serious side effects such as anaphylaxis which is a life-threatening allergic reaction, Stevens-Johnson syndrome (rare, serious disorder of the skin and mucous membranes) and diarrhea due to the bacterium C. difficile. And of course, a very important fear associated with the abuse of antibiotics is the emergence of resistance of bacteria against them. It is typical of the announcement of the World Health Organization which was issued on April 4, 2024 and which stated that “uncontrolled antimicrobial resistance due to the misuse of antibiotics is expected to reduce life expectancy and lead to unprecedented health costs and economic losses”.
Professor Merenstein noted that it is known that a cough can be a sign of a serious health problem. “It is the most common reason for visiting doctors and hospitals due to infection. The symptoms of severe cough and how they should be treated need to be studied further, possibly in a randomized clinical trial as our study was an observational study and there have been no randomized clinical trials on the issue since 2012,” he concluded.
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