25. mars 2023 00:01 – Updated 25 March 2023 00:02
The majority of adults who are admitted to hospital and are diagnosed with a respiratory virus are given antibiotics. A Norwegian study suggests that it does not reduce the risk of dying.
– A lot of antibiotics are given in hospitals without any evidence of bacterial infection. It is very common to give antibiotics in acute admissions before it is known whether there is a viral or bacterial infection, says Magrit Jarlsdatter Hovind, who is a doctor in the infectious medicine department at Ahus and a research fellow at the University of Oslo (UiO), to NTB.
She leads a Norwegian study that looks at the use of antibiotics in viral respiratory infections. They have analyzed data from 2,111 patients who, in the period 2017 to 2021, were so ill that they were admitted with a viral infection, either influenza, RSV infection or covid-19.
55 percent of them received antibiotics immediately after admission. A total of 63 percent of them received antibiotics during their admission, even though it was not proven that they had a concurrent bacterial infection.
The study shows that the proportion who died during the next 30 days was higher for those who received antibiotics than for those who did not. The risk of dying increased for each additional day of antibiotic treatment, which may seem paradoxical.
Vulnerable to side effects
The findings from the study have not yet been published, but will be presented at the international konferansen European Congress of Clinical Microbiology And Infectious Diseases (ECCMID 2023) in Copenhagen in April.
Of the 2,111 patients with the virus, 8 per cent died within 30 days.
Of those who received antibiotics, 11 percent died, while the proportion who died was 2.8 percent among those who did not receive antibiotics.
Even when the data is adjusted for age, disease severity and underlying diseases, there is a clear difference in the risk of dying. It increased the longer the treatment continued and the more doses were given.
It can almost look as if the use of medicine made the pain worse.
– This paradoxical finding is most likely due to the fact that the doctors were more inclined to give antibiotics to the patients they perceived to be the sickest, or with the most underlying morbidity, and who therefore had the highest risk of death, explains Hovind.
She says that many of the patients who are admitted with respiratory infections are old and more vulnerable to serious side effects of antibiotics.
– Antibiotic treatment should be avoided in cases where it is not necessary.
A huge problem
At the same time, Hovind emphasizes limitations of the study, including that it does not take into account contributing factors such as smoking or socio-economic background.
She says more research and larger, randomized studies are needed.
Worldwide, various respiratory infections account for 10 percent of the disease burden. Respiratory infection is the most common reason for antibiotic use, although many infections are viral and neither need nor will respond to the medication.
– Overuse of antibiotics and antibiotic resistance is a huge problem, says Hovind.
Nearly five million deaths globally in 2019 may be linked to antimicrobial resistance (AMR), according to the World Health Organization (WHO). A report from the United Nations Environment Program UNEP estimated in February that by 2050 up to ten million people could die from resistant bacteria each year.
At the same time, it is important that the medication is given when needed. Concerns that patients with covid-19 had a concurrent bacterial infection led to extensive use of antibiotics during the pandemic.
According to an article in The Lancet up to 70 per cent of hospitalized covid-19 patients received antibiotics. It turns out that the use was justified in only one out of ten cases.
