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Thursday, 01/03/2013
Acute cough alone should not be a guide symptom for antibiotic prescription
It is the conclusion of a GRACE study published in The Lancet Infectious Diseases
Acute uncomplicated lower-respiratory-tract infection, understood as cough of no more than 28 days’ duration, is the most common acute illness managed in primary care in developed countries. Even in low-antibiotic-prescribing countries, most patients with these symptoms will receive antibiotics. Although consensus opinion has been to restrict antibiotic use in such infections, the debate about the balance of benefit and harm continues. The Lancet Infectious Diseases has published an article led by the GRACE consortium addressing this problem. The work, involving over 2.000 patients in 12 countries, concludes that amoxicillin provides little benefit for acute lower respiratory-tract infection in primary care, when pneumonia is not suspected clinically. One of the authors of the article is Dr. Antoni Torres, full Professor at the University of Barcelona faculty of Medicine and leader of the IDIBAPS team Applied research in infectious respiratory diseases, critically ill patients and lung cancer. He coordinated, together with Dr. Núria Sánchez and the nurse Patricia Fernández, the tasks developed by the professionals at Casanova Primary Care Center (CAP Casanova, Barcelona).
GRACE is a Network of Excellence funded by the European Commission focusing on the complex and controversial field of community-acquired lower respiratory tract infections. This initiative, which counts with the support of IDIBAPS and Hospital Clínic of Barcelona, combats antimicrobial resistance through integrating centers of research excellence. Data from placebo-controlled trials to study antibiotics’ efficacy is scarce and inconclusive. That is the reason why overall effectiveness against acute uncomplicated lower-respiratory-tract infection, particularly in subgroups such as older people, is still debated. In the recently published work the GRACE consortium randomly assigned 1.038 patients to the amoxicillin group (1g three times daily for 7 days) and 1.023 to the placebo group. All of them were older than 18 years with cough, in whom pneumonia was not suspected.
The results show that symptom severity and duration did not differ significantly between groups, not even in the patients aged 60 years or older. The restricted benefit of antibiotics might partly be because, for most acute lower-respiratory-tract infections in primary care, bacterial pathogens can only be identified in a few patients. The GRACE consortium is already working in new strategies and biomarkers to identify these individuals that might benefit from antibiotics. In conclusion, any moderate benefits need to be balanced against the probable slight harms from treatment. Antibiotics should not be automatically administered to combat cough symptoms in absence of other clinical guide indicators. Over prescription induces the apparition of resistance to antibiotics and supposes an elevated economic cost that is not supported by scientific evidence.Related links