Study supports reducing antibiotics for sore throat, ear infections

When family doctors prescribe fewer antibiotics for coughs, colds, sore throats and ear infections, it isn't linked to an increase in the most serious bacterial complications, such as bacterial meningitis, U.K. researchers have found.

Most respiratory tract infections are caused by viruses. Antibiotics don't help to reduce the severity of symptoms or duration for viral infections, but may be associated with side-effects.

Widespread unnecessary use of antibiotics contributes to an increase in the likelihood of bacteria gaining resistance to antibiotics, leading to infections that are difficult to treat. About 60 per cent of antibiotics prescribed in primary care in the U.K. are for respiratory tract infections.

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A type of ear infection called acute otitis media is a common reason for medical visits among North American children, previous studies suggest.

Now researchers from King's College London have encouraging findings on reducing antibiotic use.

The researchers analyzed patient records from 610 general practices in the U.K. from 2005 to 2014. Practices were divided into four groups based on their antibiotic prescribing rates.

"Reducing the proportion of [respiratory tract infection] consultations with antibiotics prescribed by 10 per cent is expected to be accompanied by some 2,000 fewer antibiotic prescriptions for each practice over 10 years," Prof. Martin Gulliford and his team wrote in Monday's issue of the BMJ.

"Benefits to individuals from avoiding antibiotics include reductions in common adverse reactions to antibiotics, such as rashes, vomiting and diarrhea, which may affect 10 per cent of patients, as well as less common side-effects such as anaphylaxis."

GP offices with lower rates of antibiotic prescribing for respiratory tract infections did not have higher rates of serious bacterial complications, including:

• Meningitis.
• Mastoiditis (aninfection of the mastoid bone behind the ear).
• Empyema (infection of thelining of the lungs).
• Brain abscess or Lemierre's syndrome (an infection of the jugular vein in the neck).

These practices did have slightly higher rates of pneumonia, about one more case each year.

"As a practising GP, I see very few complications from patients who have upper respiratory tract infections and who decide to opt for a non-antibiotic approach to treating their infections," study author Dr. Mark Ashworth said in a release.

"Our paper should reassure GPs and patients that rare bacterial complications of respiratory infections are indeed rare. Fortunately, if there are any signs of a complication, the GP can quickly step in and offer an appropriate antibiotic."

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The team called for more research to look more specifically at patterns in children and older adults.

One drawback of the study is that the authors weren't able to tell if some doctors used delayed antibiotic prescribing strategies.

Antibiotic prescribing in the U.K. is high compared with some other countries, they said.

The study was funded by the U.K. National Institute for Health Research.