Is It Safe to Reduce Antibiotic Prescriptions for Respiratory Tract Infections?

Reducing antibiotic prescribing for respiratory tract infections (RTI) was associated with only a slight increase in the incidence of pneumonia and peritonsillar abscess, and was not associated with mastoiditis, empyema, bacterial meningitis, intracranial abscess, or Lemierre syndrome, according to the results of a recent study.  

Most RTIs are caused by viruses, which do not require treatment to improve. Prescribing antibiotics for these cases can not only cause unnecessary adverse side effects, but also can contribute to the development of antibiotic-resistant bacteria.  
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In order to investigate whether reducing the prescriptions of antibiotics for RTIs would increase the incidence of serious bacterial complications, including pneumonia and meningitis, the researchers analyzed the electronic health records of patients registered at 610 general practices from the UK Clinical Practice Research Datalink from 2005 to 2014.

The researchers tracked the occurrence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre syndrome.

Overall, antibiotic prescription for RTIs had decreased from 53.9% in 2005 to 50.5% in 2014 for men and from 54.5% to 51.5% for women.

From 2005 to 2014, meningitis cases decreased by 5.3%, mastoiditis cases decreased by 4.6%, and peritonsillar abscess cases decreased by 1.0% annually. However, pneumonia cases increased by 0.4%.

“General practices that adopt a policy to reduce antibiotic prescribing for RTIs might expect a slight increase in the incidence of treatable pneumonia and peritonsillar abscess,” the researchers concluded.

“No increase is likely in mastoiditis, empyema, bacterial meningitis, intracranial abscess, or Lemierre syndrome. Even a substantial reduction in antibiotic prescribing was predicted to be associated with only a small increase in numbers of cases observed overall, but caution might be required in subgroups at higher risk of pneumonia.”

—Amanda Balbi

Reference:

Gulliford MC, Moore MV, Little P, et al. Safety of reduced prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records [published online July 4, 2016]. BMJ. http://dx.doi.org/10.1136/bmj.i3410.