Antibiotics "should not be used to prevent complications from mild illness"
Publication Date:22/10/2007
Antibiotics shouldn't be used for colds, sore throats or ear infections because serious complications from these illnesses are so rare, say researchers. However they say that antibiotics may be used for chest infections because the chances of getting pneumonia after a chest infection are higher, especially in people over 65.
What do we know already?
Colds, sore throats and ear infections tend to be mild illnesses that get better on their own. They don't usually need any treatment other than painkillers. Complications can happen, but they are very rare. For example, an ear infection can very occasionally spread into the bone behind the ear, causing severe pain and swelling. This is called mastoiditis.
For many years the government has been trying to reduce the use of antibiotics for mild infections. One reason for this is that infections are often caused by viruses, and antibiotics only work against those infections caused by bacteria. Also research has shown that antibiotics don't help very much. They might cut the time you have a sore throat by about one day, for example. And antibiotics have side effects, such as stomach upset and diarrhoea.
But the biggest problem with using antibiotics a lot (for example, to treat mild illnesses like sore throats) is that bacteria can develop resistance to them so that the antibiotics no longer work. This eventually leads to the emergence of superbugs which are difficult to get rid of, like MRSA (Methicillin-resistant Staphylococcus aureus). The concern is that we will run out of antibiotics that work against this type of serious infection.
Despite guidelines telling GPs not to prescribe antibiotics for mild infections these drugs are still widely used. For example, in 2000, 60 percent of people who went to see their GP with a sore throat and 80 percent of those with earache were given antibiotics.
One of the reasons doctors prescribe antibiotics so much is to prevent a mild infection spreading and causing more serious illness. So researchers did a study to find out if antibiotics for these kinds of infections really do stop people getting complications.
What does the new study say?
The study says that doctors should not prescribe antibiotics for colds, sore throats or ear infections simply because they think this will reduce the risk of someone getting a complication. Serious problems are so rare after one of these infections that doctors would need to treat 4,000 people with antibiotics to prevent one complication.
But the risk of a chest infection spreading to the lungs and causing pneumonia is higher, especially in older people. So using antibiotics to treat a chest infection is justified. Pneumonia can need hospital treatment and can sometimes lead to death.
Tell me more about the study's findings
The study found that complications after mild infections are rare. For example, out of 10,000 people (aged 16 to 64) who did not get antibiotics for an ear infection, 12 got mastoiditis. And although antibiotics reduce the risk of this happening the difference was not very big. Out of 10,000 people who had antibiotics for ear infection, 7 got mastoiditis.
But antibiotics had a much bigger impact on whether or not people got pneumonia after a chest infection. In people over 65 who were treated with antibiotics, 146 out of 10,000 got pneumonia. But out of 10,000 people who did not get antibiotics, 403 got pneumonia.
Where does the study come from?
The study was done by researchers from University College London and the Centre for Infections at the Health Protection Agency, the government body that is responsible for public health. It was published in the medical journal the BMJ (British Medical Journal).
How reliable are the findings?
This is the best kind of study to find out the effects of antibiotics on complications. It looked at the details of 3.3 million people who were treated for a mild infection by GPs in the UK between 1991 and 2001. Researchers needed to do a study of this size, because the types of complications that can happen after mild infections are so rare that they might not happen in a smaller group of people.
What does this mean for me?
Doctors are being advised not to prescribe antibiotics for colds, sore throats or ear infections. In most cases these illnesses clear up on their own and complications are rare. So if your doctor is following the guidelines, you probably won't be prescribed antibiotics for these mild illnesses. You may be prescribed antibiotics if you have a chest infection and your doctor thinks you are at risk of getting pneumonia.
What should I do now?
The next time you get a cold or a sore throat, try taking painkillers if you think you need any medicine. Paracetamol or ibuprofen both work well. If you don't start to feel better in about three days, or you start to feel worse, then go and see your GP. But if the infection seems to be in your chest or you're having problems breathing then you should see your GP straight away. This is especially important if you're older, as you are at greater risk of getting pneumonia. One important symptom is that you're finding it harder to catch your breath. Pneumonia can also cause a high temperature, severe cough and chest pain.
From:
Petersen I, Johnson AM, Islam A, et al. Protective effect of antibiotics against serious complications of common respiratory tract infections: retrospective cohort study with the UK General Practice Research Database. BMJ. Published online 18 October 2007.
To find out more about how common infections are treated, see our information on sore throat, bronchitis, common cold, ear infections and pneumonia.
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© BMJ Publishing Group Limited ("BMJ Group") 2007. All rights reserved
This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.
