Risks and Benefits Associated With Antibiotic Use for Acute Respiratory Infections: A Cohort Study

Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio.
The Annals of Family Medicine (Impact Factor: 5.43). 03/2013; 11(2):165-172. DOI: 10.1370/afm.1449
Source: PubMed


Antibiotics are frequently prescribed for acute nonspecific respiratory infections (ARIs), presumably to avoid small risks of progression to serious bacterial illness. However, even low risks of associated adverse drug events could result in many such events at the population level. Our objective was to assess the risks and benefits of antibiotic use in a cohort of patients with ARIs, comparing outcomes of patients who were prescribed antibiotics with outcomes of patients not receiving antibiotics.

We used a June 1986 to August 2006 cohort of adult patients with ARI visits from a UK primary care database. Exposure was an antibiotic prescribed with the visit. Primary outcomes were hospitalization within 15 days for (1) severe adverse drug events (hypersensitivity, diarrhea, seizure, arrhythmia, hepatic or renal failure), and (2) community-acquired pneumonia.

The cohort included 1,531,019 visits with an ARI diagnosis; prescriptions for antibiotics were given in 65% of cases. The adjusted risk difference for treated vs untreated patients per 100,000 visits was 1.07 fewer adverse events (95% CI, -4.52 to 2.38; P = .54) and 8.16 fewer pneumonia hospitalizations (95% CI, -13.24 to -3.08; P = .002). The number needed to treat to prevent 1 hospitalization for pneumonia was 12,255.

Compared with patients with ARI who were not treated with antibiotics, patients who were treated with antibiotics were not at increased risk of severe adverse drug events and had a small decreased risk of pneumonia hospitalization. This small benefit from antibiotics for a common ambulatory diagnosis creates persistent tension; at the societal level, physicians are compelled to reduce antibiotic prescribing, thus minimizing future resistance, whereas at the encounter level, they are compelled to optimize the benefit-risk balance for that patient.

1 Follower
15 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Antimicrobial resistance (AMR) is a rapidly developing and alarming global threat which has been highlighted by national governments and public health bodies including the World Health Organisation. The spectre of a “post-antibiotic era” is a real possibility unless curtailing the development and spread of these organisms is given high priority. Numerous studies have shown that AMR is associated with worse outcomes for patients and higher healthcare costs. While clinical data from low- and middle-income countries is lacking, there is increasing evidence that the problem in these areas is as great, or even greater, than in high-income nations. Of the many drivers behind the development of antimicrobial resistance, the most significant is selection pressure caused by antibiotic use. Antimicrobial stewardship programmes are a set of interventions that aim to ensure the judicious use of antimicrobials by preventing their unnecessary use, and by providing targeted and limited therapy in situations where they are warranted. The ultimate goal of these programmes is to provide effective antimicrobial therapy whilst safeguarding their effectiveness for future generations. Whilst they do require an initial investment, they have been shown to be an effective way of controlling antimicrobial use, and have been associated with improved patient outcomes and reduced healthcare costs.
    British Journal of Clinical Pharmacology 05/2014; 79(2). DOI:10.1111/bcp.12417 · 3.88 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The spread of antibiotic-resistant pathogens requires new treatments. As the rate of development of new antibiotics has severely declined, alternatives to antibiotics must be considered in both animal agriculture and human medicine. Products for disease prevention are different from those for disease treatment, and examples of both are discussed here. For example, modulating the gut microbial community, either through feed additives or fecal transplantation, could be a promising way to prevent certain diseases; for disease treatment, non-antibiotic approaches include phage therapy, phage lysins, bacteriocins, and predatory bacteria. Interestingly, several of these methods augment antibiotic efficacy by improving bacterial killing and decreasing antibiotic resistance selection. Because bacteria can ultimately evolve resistance to almost any therapeutic agent, it is important to continue to use both antibiotics and their alternatives judiciously.
    Annals of the New York Academy of Sciences 06/2014; 1323(1). DOI:10.1111/nyas.12468 · 4.38 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Acute respiratory infections (ARIs) are a major burden on healthcare systems. ARIs—including non-specific upper respiratory infections (the common cold), otitis media, sinusitis, pharyngitis, acute bronchitis, influenza, and pneumonia—are the number-one symptomatic reason for seeking medical care. In the United States, ARIs account for about 10 % of all ambulatory visits.Among ARIs, the diagnosis and management of acute bronchitis should be particularly straightforward. Acute bronchitis is a cough-predominant respiratory infection of less than 3 weeks’ duration in a patient without chronic cardiopulmonary disease who has normal vital signs and a normal lung examination. Forty years of randomized controlled trials, as well as more recent guidelines and performance measures, indicate that antibiotics are not beneficial for acute bronchitis and that the right antibiotic prescribing rate is zero.Despite clear evidence, guidelines, and measures indicating that physicians should avoid prescr ...
    Journal of General Internal Medicine 01/2015; 30(4). DOI:10.1007/s11606-015-3181-1 · 3.45 Impact Factor
Show more