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No antibiotics for URTI backed by research

GPs can reassure patients wanting antibiotics for upper respiratory tract infections that the chances of them developing a serious complication is ‘extraordinarily low', say UK primary care researchers.

But the risk is significant enough – particularly in the elderly – to justify prescribing antibiotics to prevent pneumonia and other complications following a chest infection.

Researchers compared the risk of serious complications in patients treated with antibiotics to those who were using data from 3.36 million RTIs recorded in the General Practice Research Database.

They found that serious complications after upper RTIs, sore throat and otitis media are so rare that more than 4,000 patients need to be treated with antibiotics to prevent a one serious complication.

However, the number needed to treat to prevent a pneumonia after a chest infection was much lower - 39 in over 65s and between 96 and 119 in younger age groups.

Researcher Dr Andrew Hayward, senior lecturer in infectious disease epidemiology at University College London, said the main message was that the risk of complications after RTIs was ‘extraordinarily low'.

‘Where there is more justification is for chest infections. The risk is appreciable and can be lowered with antibiotics, particularly in the elderly. It kind of validates what GPs are already doing, and how they are managing chest infections.'

Professor Azeem Majeed, professor of primary care at Imperial College London and a GP in Clapham, London, said: ‘The factors that influence GPs into prescribing antibiotics are quite complex. It's often a combination of clinical uncertainty, expectations of the patients or parent, or previous experiences.'

But he added: ‘This study is important, because it means we can reduce the prescription of antibiotics for upper RTIs, sore throat and otitis media without major public health effects.'

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