A new study of 718 patients who sought treatment in U.S.-based primary and emergency care settings found that antibiotics were ineffective in providing symptomatic relief from lower respiratory tract infections. Out of the 718 patients included in the study, 29% had been prescribed common antibiotics like amoxicillin-clavulanate, azithromycin, doxycycline, and amoxicillin.
“Provision of an antibiotic had no effect on the duration or overall severity of cough, including in patients with viral, bacterial, and mixed infections,” the researchers wrote in the study that was published in the Journal of General Internal Medicine on April 15, 2024.
In a press release, lead author Dan Merenstein, a professor of family medicine at Georgetown University School of Medicine said: “Lower respiratory tract infections tend to have the potential to be more dangerous, since about 3% to 5% of these patients have pneumonia. But not everyone has easy access at an initial visit to an X-ray, which may be the reason clinicians still give antibiotics without any other evidence of a bacterial infection. Plus, patients have come to expect antibiotics for a cough, even if it doesn’t help. Basic symptom-relieving medications plus time brings a resolution to most people’s infections.”
“We know that cough can be an indicator of a serious problem. It is the most common illness-related reason for an ambulatory care visit, accounting for nearly 3 million outpatient visits and more than 4 million emergency department visits annually,” added Merenstein. “Serious cough symptoms and how to treat them properly needs to be studied more, perhaps in a randomized clinical trial as this study was observational and there haven’t been any randomized trials looking at this issue since about 2012.”
Another study author, Mark H. Ebell, a professor in the College of Public Health at the University of Georgia, highlighted in a press release that physicians tend to “overestimate the percentage of lower tract infections that are bacterial.”
“They also likely overestimate their ability to distinguish viral from bacterial infections,” added Ebell. “In our analysis, 29% of people were prescribed an antibiotic while only 7% were given an antiviral. But most patients do not need antivirals as there exist only two respiratory viruses where we have medications to treat them: influenza and SARS-COV-2. There are none for all of the other viruses.”
Antibiotic overuse and the over-prescribing of antibiotics has led to drug-resistant bacteria that are much harder to treat. In fact, within the last two decades, antibiotic resistance has become a global public health threat which caused more than one million deaths worldwide in 2019, according to the Lancet.
Other than the growing threat of antibiotic resistance, one in 300 patients can also experience severe side-effects from frequently using antibiotics. A 2023 study reported that one of the rare adverse events could be a potentially fatal diarrheal infection called Clostridium difficile. Researchers estimate that in the U.S. alone, doctors give out 34 million unnecessary antibiotic prescriptions every year.
At present, antibiotic resistance is far more prevalent in low-income and middle-income countries — thanks to the financial incentives that doctors get from over-prescribing antibiotics.
