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GPs buried under trusts' workload dump

Advisers urge use of antibiotics in all cases of LRTI

GPs should prescribe antibiotics for all lower respiratory tract infections, irrespective of general health or smoking status, research by Government advisers concludes.

It is impossible to safely withhold antibiotics on current evidence, the study concluded. The research team included Health Protection Agency researchers and two members of the Government's Specialist Advisory Committee on Antimicrobial Resistance.

Their study – presented at the HPA's annual conference last week – found neither smoking status nor previous respiratory conditions were able to predict whether patients needed antibiotics.

In those aged 65 and over, the number needed to treat to prevent one case of pneumonia was just 47 and in those aged up to four it was 146.

'Do prescribe antibiotics for

LRTIs even in previously healthy non-smokers,' the study said.

The researchers said efforts to reduce antibiotic use should instead focus on distinguishing between upper and lower respiratory tract infections (see box, below right).

In the study, patients with nasal symptoms and coughs and sneezing without sputum were classed as having URTIs, and those with acute bronchitis, chest infections and productive cough as having LRTIs.

Antibiotics were not indicated in upper respiratory tract infections, sore throats and otitis media, concluded the research, on data from 162 GP practices.

Study leader Dr Andrew Hayward, senior lecturer in infectious disease and epidemiology at University College London, said: 'For LRTIs, one should be considering treating with antibiotics but for URTIs you would certainly discourage it. It's very clear that the elderly are a group in whom the number needed to treat for LRTIs was really very low.'

Several research studies have found a clampdown on antibiotic prescribing can drive rising rates of pneumonia.

Dr Mike Thomas, an author of one such study and research fellow at the University of Aberdeen, said: 'Once we overused antibiotics; perhaps now we've gone too far the wrong way.'

Dr Iain Small, chair of the General Practice Airways Group's education committee and a GP in Peterhead, Aberdeenshire, said: 'What we need is some clear guidance on who we should be treating.'

dcressey@cmpmedica.com

Diagnosing LRTI

Class as LRTI if (all required):

• an acute illness present for 21 days or less

• cough as cardinal symptom

• at least one other lower respiratory tract symptom (sputum production, dyspnoea, wheeze, chest discomfort/pain)

• no alternative explanation –

for example, not sinusitis, pharyngitis or a new presentation of asthma.

Source: Macfarlane et al, Thorax 2001;56:109-114 (February)

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