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Antibiotics offer almost no benefit to patients with acute lower respiratory tract infections, the largest study to date reveals.

Prescribing antibiotics had no effect on the duration or severity of coughs and only a marginal effect on other symptoms, according to the randomised trial of 807 patients.

Lead researcher Professor Paul Little said the results were likely to have a big impact on GP management of lower respiratory infections, as there had been a 'scandalous lack of evidence' up to now.

The only significant effect of antibiotics was to shorten by less than a day – in the context of a two-week illness – symptoms other than coughs, such as sputum, shortness of breath and sleep disturbance.

'Is that small benefit worth it? I would say not, but it is between GPs and their patients to decide,' said Professor Little, professor of primary care research at the University of Southampton.

Dr Mike Thomas, a GP in Minchinhampton, Gloucester, and General Practice Airways Group research fellow, said there had been no guidance for GPs in this area because of a lack of evidence.

GPs tended to err on the side of caution because of concerns the illness might pro-gress, he said.

Professor Little, who presented his findings to the Society of Academic Primary Care in Glasgow last week, said other studies suggested elderly patients or those with green sputum might benefit prefer- entially from antibiotics.

He conceded GPs should be cautious about denying antibiotics to the elderly or those with significant comorbidity – but said delaying scripts might be a suitable compromise.

Dr Alastair Hay, clinical lecturer in primary care at the University of Bristol and a GP in the city, said: 'This is a great study – GPs will be updating their practice in the light of the results.'

Dr Hay presented his own research revealing that receiving antibiotics increases a patient's risk of resistant urinary tract infection.

Professor Little added: 'LRTI is probably the commonest thing we manage as GPs. We have to balance that against the high potential public health threat from antibiotic resistance.'

By Jo Haynes

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