Antibiotics are no better than a placebo for coughing
The antibiotic amoxicillin shows no therapeutic benefit for cough, but with increased side effects. An international team of researchers examined the use of the antibiotic in lower respiratory tract infections more closely and found that the effect was comparable to that of a placebo. However, side effects were more common after taking antibiotics, the scientists under Professor Paul Little from the University of Southampton (UK) report in the specialist magazine "The Lancet".
"Infections of the lower respiratory tract are one of the most common acute illnesses in primary care" and an antibiotic is often provisionally prescribed, although the cough is mostly caused by viruses and not by bacteria, the researchers write. So far, only a few placebo-controlled studies on the use of antibiotics in acute cough have been carried out and "the general effectiveness (especially in subgroups such as the elderly) is controversial", Prof. Little and colleagues justified their current research approach. They compared the benefits and harms of amoxicillin for acute lower respiratory infections with the effects of a placebo.
Antibiotics ineffective in respiratory infections? A total of 2,061 patients over the age of 18 years "with acute lower respiratory infections (cough of ≤ 28 days duration), who were not suspected of pneumonia, were randomized to an amoxicillin group (taking one gram three times a day for seven days) and divided a placebo group, ”the scientists report. An observation followed until the time of recovery. According to one of the results, the antibiotic had no significantly better effect than the placebo in alleviating the symptoms or in the duration of the disease. This also applies explicitly to use by senior citizens. However, the researchers in the amoxicillin group observed significantly fewer "new or worsening symptoms." In the placebo group, 19.3 percent of the patients had observed worsening of existing complaints or the appearance of new symptoms, while only 15.9 Percent of patients in the antibiotic group applied. However, that means that 30 patients have to be treated with amoxicillin to prevent the deterioration in one case, explained Prof. Little.
Increased occurrence of side effects due to the antibiotic According to the researchers, the increased occurrence of side effects speaks against the use of the antibiotic for respiratory infections. The subjects in the amoxicillin group suffered significantly more from itchy rash, diarrhea, nausea and vomiting. In one case, taking the antibiotic even led to anaphylaxis. Overall, 24 percent of the patients had side effects in the placebo group, compared to 28.7 percent in the antibiotic group. According to the scientists, two patients from the placebo group and one patient from the amoxicillin group had to be hospitalized. No deaths occurred in the study.
General practitioners should be able to do without antibiotics more often for respiratory infections "If no pneumonia is suspected, amoxicillin offers little clinical benefit for acute infections of the lower respiratory tract both overall and in patients aged 60 years or more," report Prof. Little and colleagues. In addition, there are more side effects to be expected with the antibiotic. Most patients would recover on their own even without the use of antibiotics, although in some cases the antibiotic counteracted a deterioration in their health. In the future, it is important to identify the patients who can actually benefit from the antibiotic. Overall, the investigation by the research team led by Prof. Little shows that general practitioners can often do without antibiotics in the treatment of lower respiratory tract infections, explained Philipp Schütz from the Medical University Department of the Aarau Cantonal Hospital (Switzerland) in a comment on the current article. This applies in particular to low-risk patients without suspected pneumonia. (fp)
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