Reducing Antibiotics for RTIs May Not Raise Likelihood of Bacterial Complications

Reducing antibiotic prescribing for self-limiting respiratory tract infections (RTIs) may not raise the likelihood of developing serious bacterial complications, such as bacterial meningitis, mastoiditis, and empyema, according to a new study from the United Kingdom.

“Primary care accounts for 75% of antibiotic prescribing in the UK, with 60% of this amount prescribed for RTIs,” said author Martin C Gulliford, FFPH, King’s College, London. “With the growing threat of antimicrobial resistance, it is now timely to address the imbalance of benefits and harms associated with unnecessary antibiotic prescribing.”

Researchers conducted a cohort study involving analyzing patient records from more than 600 UK general practices from the UK Clinical Practice Research Datalink to assess whether prescribing fewer antibiotics for self-limiting RTIs results in a higher incidence in RTI complications, namely pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre’s syndrome. They looked at the data for 4.5 million patients over a 10-year period.

Dr Gulliford and colleagues found that the proportion of antibiotics prescribed decreased from approximately 54% to 50.5% in men and from 54.5% to 51.5% in women from 2005 to 2014. In addition, new episodes of meningitis decreased by 5.3%, mastoiditis decreased by 4.6%, peritonsillar abscess decreased by 1.0%, and pneumonia increased by 0.4% annually during this time period. Practices with low and high prescribing rates reported a similar number of mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre’s syndrome cases.

“Our study shows that risks remain small even when a policy to reduce antibiotic prescribing is adopted. We did find that low antibiotic prescribing family practices experienced slightly higher rates of pneumonia and peritonsillar abscess, but the numbers of cases are expected to be small, and these complications are treatable with antibiotics.”

The authors call for additional research to quantify associations based on individual patient characteristics and consultation patterns in the primary care setting, as well as large randomized trials to evaluate safety outcomes of antibiotic prescribing reduction strategies.

“This study provides reassurance for primary care physicians that it will generally be safe to avoid antibiotic prescriptions for self-limiting RTIs because the risk of infective complications generally remains low, even when antibiotics are not prescribed,” said Dr Gulliford.

“Avoiding unnecessary antibiotic prescriptions reduces the risk of future antimicrobial resistance, it reduces risks to patients of side effects of antibiotic treatment, and it avoids the medicalization of illnesses that are usually self-limiting,” he added. “Pharmacists can help patients by offering appropriate advice on self-care for RTIs. They can also advise of warning signs—such as chest pain or shortness of breath- that may raise concern.”

—Meredith Edwards White