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Dramatic benefits for early antibiotics in at-risk patients with LRTI

By Lilian Anekwe

Prescribing antibiotics on the day of diagnosis of a lower respiratory tract infection ‘dramatically' reduces admissions and mortality related to respiratory infection, UK research reports.

Antibiotic prescribing on the day of diagnosis lowered the rate of admissions by 27% and reduced mortality by as much as 69%.

In comparison, antibiotic prescribing in the previous seven days was associated with a 92% increased risk of admission and a 56% increased risk of mortality.

The study, published in Chest this month, analysed records from the UK general practice research database on 151,000 patients with a median age of 54 years, who received a first diagnosis of a LRTI during 2004.

Study leader Professor David Price, professor of primary care respiratory medicine at the University of Aberdeen and a GP in Norwich, said the immediate prescription of an antibiotic for patients with LRTI ‘may reduce the risk of subsequent adverse outcome'.

‘While controversial, this explanation is plausible. A cautious approach may be needed when considering which patients consulting with LRTI need to be prescribed an antibiotic, particularly in high-risk vulnerable groups.'

Dr Rupert Jones, a GP in Plymouth and a member of the General Practice Airways Group's research committee, said: ‘A 69% reduction is surprising and dramatic, but if it's in the context of a relatively low prevalence of admissions and mortality perhaps less so.

‘It's extremely rare for a person with normal healthy airways to be admitted or to die from an uncomplicated LRTI, but this is more of a risk in people with unhealthy airways, for example with COPD.'

Dr Iain Small, a GP in Peterhead, Aberdeenshire, said the study vindicated GPs.

‘As a profession we have been castigated for prescribing antibiotics early. But this shows early use if antibiotics is probably going to lower your risk of ending up in hospital or dying. The general public health message to avoid antibiotics is the right one, but for the elderly and those with comorbidities the message should be slightly different.'

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