For bronchitis, antibiotic no better than placebo

U. SOUTHAMPTON (UK) — The antibiotic amoxicillin is no more effective at relieving symptoms of common chest infections like bronchitis than the use of no medication at all, even in older patients.

“Patients given amoxicillin don’t recover much quicker or have significantly fewer symptoms,” explains Paul Little, professor of primary care research at the University of Southampton.


“Indeed, using amoxicillin to treat respiratory infections in patients not suspected of having pneumonia is not likely to help and could be harmful. Overuse of antibiotics, which is dominated by primary care prescribing, particularly when they are ineffective, can lead to side effects such as diarrhea, rash, vomiting, and the development of resistance.”

Chest infections are one of the most common acute illnesses treated in primary care in developed countries. Although viruses are believed to cause most of these infections, whether or not antibiotics are beneficial in their treatment, particularly in older patients, is still hotly debated. Research so far has produced conflicting results.

For this study, published in the Lancet Infectious Diseases, 2,061 adults with acute uncomplicated lower respiratory tract infections from primary care practices in 12 European countries (England, Wales, Netherlands, Belgium, Germany, Sweden, France, Italy, Spain, Poland, Slovenia, and Slovakia) were randomly assigned to receive either amoxicillin or a placebo three times a day for seven days.

Doctors assessed symptoms at the start of the study and participants completed a daily symptom diary.

Little difference in severity or duration of symptoms was reported between the two groups. This was true even for older patients aged 60 or older who were generally healthy, in whom antibiotics appeared to have a very limited effect.

Although significantly more patients in the placebo group experienced new or worsening symptoms (19.3 percent vs. 15.9 percent), the number needed to treat was high (30), and just two patients in the placebo group and one in the antibiotic group required hospitalization.

What is more, patients taking antibiotics reported significantly more side effects including nausea, rash, and diarrhea, than those given placebo (28.7 percent vs. 24 percent).

“Our results show that most people get better on their own. But, given that a small number of patients will benefit from antibiotics the challenge remains to identify these individuals,” Little says.

Source: University of Southampton