This open access article was published more than a year and a half ago in Lancet Infectious Diseases – one of the top journals for clinical infectious diseases research. 2,061 patients aged 18 years and older from 12 European countries were recruited when they presented to primary care (GP) practices for acute lower respiratory tract infections (LRTIs) where pneumonia was not clinically suspected (i.e. mostly acute bronchitis). Approximately half received oral amoxicillin while the other half (1,023 patients) received placebo. Patients with nausea, diarrhea or rash were more likely to be in the group that received the antibiotic, whereas there was no benefit in terms of time to symptom resolution, worsening symptoms or prevention of hospitalization. Neither age nor colour of sputum made a difference. 15% of the patients had either asthma or chronic obstructive pulmonary disease (COPD).
This study is very important in terms of making us re-evaluate our clinical practice, where antibiotics are frequently prescribed in our primary care for LRTI where pneumonia is not suspected, and even for URTIs. Very often, doctors (and patients!) only worry about one side of the equation – that there is a possible bacterial infection – and not enough about the flip side – where the probabilities of adverse effects from antibiotics and selection of antibiotic resistance are very real.