Antibiotics for coughing useless

Antibiotics do not work better in coughs than placebo

19/12/2012

The antibiotic amoxicillin shows no therapeutic benefit in cough, but with increased side effects. An international research team has studied the use of the antibiotic for lower respiratory tract infections more closely and found that the effect was comparable to that of a placebo. However, there were more side effects after taking the antibiotics, say the researchers around Professor Paul Little of the University of Southampton (UK) in the journal „The Lancet“.

„Lower respiratory infections are one of the most common acute diseases in primary care“ and not infrequently, an antibiotic is prescribed provisionally, although the cough is usually caused by viruses and not by bacteria, the researchers write. So far only a few placebo-controlled studies on antibiotic use in acute cough have been carried out and „overall effectiveness (especially in subgroups such as the elderly) is controversial“, Prof. Little and colleagues explained their current research approach. They compared the benefits and harms of amoxicillin for acute lower respiratory tract infections with the effect of a placebo.

Antibiotics in respiratory infections ineffective?
A total of 2,061 patients over the age of 18 years „with acute lower respiratory infections (cough of ≤ 28 days) who were not suspected to have pneumonia were randomized to one group of amoxicillin (taking one gram three times daily for seven days) and one placebo group“, the scientists report. This was followed by observation until the time of recovery. Neither in relieving the symptoms nor in the duration of the disease did the antibiotic have a significantly better effect than the placebo, according to one of the results. This applies explicitly also for the employment with seniors. However, the researchers observed significantly less in the amoxicillin group „new or worsening symptoms.“ In the placebo group, 19.3 percent of patients had experienced worsening of existing symptoms or new symptoms, compared with only 15.9 percent of patients in the antibiotic group. However, this means that 30 patients would need to be treated with amoxicillin to prevent deterioration in a single case, said Professor Little.

Increased occurrence of side effects due to the antibiotic
According to the researchers, the increased occurrence of side effects speaks in favor of the use of the antibiotic in respiratory infections. The subjects of the amoxicillin group suffered significantly more often from itchy rash, diarrhea, nausea and vomiting. In one case, taking the antibiotic even led to anaphylaxis. Overall, in the placebo group, 24 percent of patients had side effects, in the antibiotic group, there were 28.7 percent. According to the researchers, two patients from the placebo group and one patient from the amoxicillin group had to be hospitalized. Deaths did not occur in the study.

Family doctors should be able to do without antibiotics more frequently if they have respiratory infections
„If no pneumonia is suspected, amoxycillin has little clinical benefit for acute lower respiratory tract infections, both overall and in patients 60 years of age or older“, Report Prof. Little and colleagues. In addition, there are more side effects to be expected with the antibiotic. Most patients would recover without antibiotics use alone, but the antibiotic occasionally quite a counteracted worsening of health. In the future, it will be important to identify the patients who actually benefit from the antibiotic. Overall, the study of the research team led by Prof. Little, that general practitioners in general can dispense with antibiotics in the treatment of lower respiratory infections, said Philipp Schütz of the Medical University Department of the Cantonal Hospital Aarau (Switzerland) in a commentary on the current article. This applies in particular to low-risk patients without suspected pneumonia. (Fp)

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