Immediate antibiotics for uncomplicated RTIs do not reduce risk of admission and death, study findsBMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2496 (Published 23 May 2017) Cite this as: BMJ 2017;357:j2496
Offering a delayed rather than an immediate prescription for antibiotics to adults with lower respiratory tract infections is associated with a lower likelihood of a subsequent GP consultation and no increased risk of hospital admission or death, a study published in The BMJ shows.1
The study included 28 779 adults presenting to UK general practice with lower respiratory tract infections, whose main symptom was acute cough for as long as three weeks. Patients with serious illness were excluded.
Outcomes including repeat consultation, hospital admission, and death within 30 days of the initial consultation were compared among the three prescribing strategies: no antibiotics, delayed antibiotics, and immediate antibiotics.
The results showed that subsequent hospital admission or death occurred in 26 of 7332 patients (0.3%) who received no antibiotic prescription, 156 of 17 628 (0.9%) who received immediate antibiotics, and 14 of 3819 (0.4%) who received a prescription for delayed antibiotics. Multivariable analysis documented no reduction in hospital admission or death after immediate antibiotics (risk ratio 1.06 (95% confidence interval 0.63 to 1.81); P=0.84) and a non-significant reduction with delayed antibiotics (0.81 (0.41 to 1.64); P=0.61).
Repeat consultation for new, worsening, or non-resolving symptoms was common, occurring in 19.7% (1443/7332) of patients who received no antibiotics, 25.3% (4455/17 628) who had immediate antibiotics, and 14.1% (538/3819) with a delayed prescription. Multivariable analysis showed that the likelihood of a repeat consultation was significantly reduced by delayed antibiotics (0.64 (0.57 to 0.72); P<0.001) but not by immediate antibiotics (0.98 (0.90 to 1.07); P=0.66).
The researchers concluded, “Prescribing immediate antibiotics may not reduce subsequent hospital admission or death for young people and adults with uncomplicated lower respiratory tract infection, and such events are uncommon.
“If clinicians are considering antibiotics, a delayed prescription may be preferable since it is associated with reduced number of reconsultations with worsening illness.”
A quarter of patients (25.5%) in the study received no prescription for antibiotics, and (13.3%) received a delayed prescription. The remaining 61.3% received a prescription for immediate antibiotics, meaning that the drugs were prescribed “far more often than might be expected from good evidence of poor effectiveness,” said a linked editorial by Anna Mae Scott, senior research fellow, and Chris Del Mar, professor of public health, at the Centre for Research in Evidence Based Practice at Bond University in Queensland, Australia.2
They noted a Cochrane review of six trials in which patients with acute bronchitis were randomly assigned antibiotics or placebo, where antibiotics reduced the duration of cough by less than half a day.3