Are Antibiotics Needed for Lower Respiratory Tract Infections?

Researchers in Europe who examined the disease progression of about 800 adults diagnosed with lower respiratory tract infections found that many improved without the use of antibiotics.

Physicians may prescribe antibiotics out of fear that bacterial infections are more serious than viral infections,  the researchers said, but they found little evidence to confirm that fear. The course of illness in patients with bacterial infections (162 people) did not differ in a “clinically meaningful way” from those infected with viruses (672 people.)

However, the study left out the most severely ill patients, who were hospitalized, and did not follow patients who still felt unwell at the end of the four week trial.

Even so, the findings add to a growing body of evidence suggesting that antibiotics may not benefit people with respiratory infections, particularly when pneumonia isn’t suspected, said Dr. Louise Vaz, an infectious disease researcher at Oregon Health and Science University’s Doernbecher Children’s Hospital in Portland.

“Antibiotics will be needed if there is concern for pneumonia,” Vaz, who wasn’t involved in the study, said by email. “However, for the majority of patients presenting to their doctor for cough, antibiotics may not be needed.”

Each time patients take antibiotics they don’t need, they also contribute to the development of superbugs that are resistant to treatment with these medicines, noted Dr. Sharon Meropol, a researcher at Case Western Reserve University School of Medicine in Cleveland, Ohio.

“The bigger picture is that the more antibiotics we use for society as a whole, the faster antibiotic resistance will develop, and future bacterial infections for all of our patients will become increasingly difficult to treat,” Meropol said by email.

“That’s why judicious antibiotic use, using them only when they are likely to be of benefit, will preserve antibiotics’ usefulness as long as possible for each of us individually, as well as for society as a whole,” Meropol added.

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