Blog | Monday, March 25, 2013

QD: News Every Day--Doctors balance patient's respiratory infections vs. drug resistance


Patients who were treated with antibiotics for nonspecific acute respiratory infections were not at increased risk of severe adverse drug events and had a small decreased risk of hospitalization for pneumonia compared to those who were not treated with antibiotics, according to a review of 1.5 million patients.

To assess the risks and benefits of antibiotic use, researchers assessed records of adult patients from June 1986 to August 2006 from a U.K. primary care database. Results appeared in the Annals of Family Medicine.

The cohort included more than 1.5 million visits, of which 65% resulted in a prescription for antibiotics. Antibiotic prescribing among the 326 practices ranged from 3% to 95% of visits. Amoxicillin was most frequently prescribed (51.2%), followed by penicillin (17%) and erythromycin (12.7%).

There were 0.37 fewer events per 100,000 patient visits (95% CI, -5.31 to 2.07) for patients treated vs. not treated with antibiotics. The adjusted risk difference for treated vs. untreated patients per 100,000 visits was 1.07 fewer adverse events (95% confidence interval [CI], -4.52 to 2.38; P=.54) and 8.16 fewer pneumonia hospitalizations (95% CI, -13.24 to -3.08; P=.002). The number needed to treat to prevent 1 hospitalization for pneumonia was 12,255.

Researchers wrote, "Although the number needed to treat to prevent 1 pneumonia hospital admission exceeds generally accepted thresholds for preventing serious infections, antibiotic treatment of ARIs is still common; the precise value of that boundary can depend on the perspective of the decision maker and, even for the most conscientious of us, may differ between what we may deem ideal for society in general and what we decide for the patient sitting in front of us."