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Antibiotics for respiratory infections decreased hospitalization risk
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Patients prescribed antibiotics for acute nonspecific respiratory infections were at no greater risk for adverse drug events and had fewer hospitalizations due to pneumonia compared with patients who were not treated with the drugs, researchers reported. The study results speak to the balance between eliminating unnecessary antibiotic use for the greater public health benefit and providing the best treatment for the individual patient.
“This small benefit from antibiotics for a common ambulatory diagnosis creates persistent tension; at the societal level, physicians are compelled to reduce antibiotic prescribing, thus minimizing future resistance, whereas at the encounter level, they are compelled to optimize the benefit-risk balance for that patient,” the researchers wrote.
Sharon B. Meropol, MD, PhD, of Case Western Reserve University School of Medicine, and colleagues examined the prevalence of hospitalizations due to severe adverse drug reactions and community-acquired pneumonia among 1,531,019 adult patients with an acute nonspecific respiratory infection diagnosis. Antibiotic prescriptions were assigned in 65% of cases.
The risk difference was 1.07 (95% CI, –4.52 to 2.38) fewer adverse events and 8.16 (95% CI, –13.24 to –3.08) fewer pneumonia hospitalizations per 100,000 visits for antibiotic-treated patients vs. untreated patients. According to the researchers, the number needed to treat to prevent one hospitalization for pneumonia was 12,255 patients, exceeding established thresholds for preventing infection.
According to Meropol and colleagues, it is ultimately up to the clinician to weigh the risks associated with antibiotic use and the welfare of the general public.
“[T]he precise value of that boundary can depend on the perspective of the decision maker and, even for the most conscientious of us, may differ between what we may deem ideal for society in general and what we decide for the patient sitting in front of us,” they wrote.
Disclosure: The researchers report no relevant financial disclosures.
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