Are antibiotics effective for lower respiratory tract infections?

According to a study published in the Journal of General Internal Medicine, the use of antibiotics provided no measurable impact on the severity or duration of coughs even if a bacterial infection was present.

“Upper respiratory infections like colds, sore throats, and sinus infections have clear antibiotic guidelines. Lower respiratory infections, including pneumonia, affect 3-5% of patients and often prompt antibiotic use due to limited access to X-rays and patient expectations. However, symptom relief and time typically resolve most infections,” said the study’s lead author, Dan Merenstein.

In the study, researchers prescribed antibiotics to people who sought treatment or urgent care settings for lower respiratory tract infections. They used advanced lab tests to identify bacterial or viral infections, categorizing them as bacterial-only, viral-only, both viral and bacterial, or no organism detected.

The results showed that of the 29% of people given an antibiotic during their initial medical visit, there was no effect on the duration or overall severity of cough compared to those who didn’t receive an antibiotic.

“In our analysis, 29% of people were prescribed an antibiotic while only 7% were given an antiviral. But most patients do not need antivirals as there exist only two respiratory viruses where we have medications to treat them: influenza and SARS-COV-2. There are none for all of the other viruses.” said Mark H. Ebell, the study’s author.

Overuse of antibiotics can result in dizziness, nausea, diarrhea, and rash along with about a 4% chance of serious adverse effects including anaphylaxis, which is a severe, life-threatening allergic reaction. Another significant concern of the overuse of antibiotics is resistance. Uncontrolled antimicrobial resistance, due to the overuse of antibiotics, is expected to lower life expectancy and lead to unprecedented health expenditure and economic losses.

Reference: Dan Merenstein, et al.; Antibiotics not associated with shorter duration or reduced severity of acute lower respiratory tract infection; Journal of General Internal Medicine