antibiotics does not work better in coughs than placebo
The antibiotic amoxicillin shows no therapeutic benefit in cough, but with increased side effects. An international team of researchers has studied the use of the antibiotic for lower respiratory infections and found that the effect was comparable to placebo. However, there were more side effects after taking the antibiotics, say scientists around Professor Paul Little of the University of Southampton( UK) in the journal "The Lancet".
"Lower respiratory tract infections are one of the most common acute diseases in primary care" and not infrequently also be prescribed antibiotic, although the cough is mostly due to viruses and notcaused by bacteria, the researchers write. So far, only a few placebo-controlled studies on antibiotic use in acute cough have been conducted and "the overall effectiveness( especially in subgroups such as the elderly) is controversial," said Prof. Little and colleagues 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 18 years of age with acute lower respiratory tract infections( cough of ≤ 28 days duration) who were not suspected of having pneumonia were randomized to an amoxicillin group( taking one gram three times daily for seven days)and a placebo group, "the scientists report. There followed an 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, researchers in the amoxicillin group observed significantly fewer "new or worsening symptoms." In the placebo group, 19.3 percent of patients had experienced worsening of existing symptoms or the onset of new symptoms, while only 15.9Percent 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, explained Professor 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 in respiratory infections. Thus, 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.
GPs should refrain from antibiotics more frequently in respiratory infections
"If no pneumonia is suspected, amoxicillin provides clinically limited benefits 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 alone, but the antibiotic occasionally quite a deterioration of the state of health had counteracted. 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 tract 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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