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Common Antibiotic Not Helpful for Cough and Respiratory Infection

The views expressed are those of the author and are not necessarily those of Scientific American.


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antibiotic not effective cough respiratory infection

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When I was growing up in the 1980s and ’90s with two younger brothers, the antibiotic amoxicillin was a frequent guest in our house. Strep throat, sinus infections, sore throats, coughs; we all remember that thick, pink, bubble gum-flavored liquid perhaps a little too well. But this popular drug, like many antibiotics, is overprescribed—often given for illnesses that it will not help, such as viral infections. A new study shows that it is indeed no more helpful than a placebo in treating patients with a non-pneumonia lower respiratory tract infection, such as a nagging cough.

The research complements a paper published in February in JAMA, The Journal of the American Medical Association, that found that amoxicillin (know by names such as Amoxil, Alphamox, Dispermox, Trimox and others) is not effective in treating sinus infections when tested against a placebo.

For the new study, published online December 18 in The Lancet Infectious Diseases, researchers recruited 2,061 patients 18 years and older (across a dozen European countries) who went to their doctor for a lower-respiratory infection that was not suspected to be pneumonia and had a cough lasting fewer than four weeks. Half of the hackers were randomly assigned to receive amoxicillin and the other half received a placebo. Both groups were instructed to take their medication three times a day for seven days; and neither the patients nor clinicians knew which treatment was which. Participating patients received follow-up phone interviews and completed daily diary entries for symptoms (detailing, for example, cough, phlegm, runny nose, headaches, feeling unwell, etc.) as well as for side effects (including diarrhea, rashes, vomiting, etc.) for up to four weeks.

The severity or length of moderate or intense symptoms was about the same for both the antibiotic and placebo groups. And there was only a slightly higher rate of new or worsening symptoms for those patients taking a placebo (19.3 percent) than for those taking the antibiotic (15.9 percent). The findings held even in patients 60 and older, who have been thought to benefit more from antibiotic treatment for such infections.

“Patients given amoxicillin don’t recover much quicker or have significantly fewer symptoms,” said Paul Little, of Primary Care and Population Sciences Division at the University of Southampton in the U.K., and co-author on the new study, in a prepared statement. “Our results show that most people get better on their own.”

What’s more, the study showed that more people taking the amoxicillin (which is in the penicillin family) experienced side effects such as diarrhea, rashes and/or vomiting than those taking the placebo.

The findings “should encourage physicians in primary care to refrain from antibiotic treatment in low-risk patients,” said Philipp Schuetz of the Medical University Department Kantonsspital Aarau in Switzerland in a prepared statement. Schuetz wrote an essay published in the same issue of The Lancet Infectious Diseases. For the subset of patients for whom the drug appeared to have had a slight benefit, researchers could now begin looking to see what might set them—or their infections—apart. “Guidance from measurements of specific blood biomarkers of bacterial infection might help to identify the few individuals who will benefit from antibiotics despite the apparent absence of pneumonia and avoid the toxic effects and costs of those drugs,” Schuetz said.

Amoxicillin is the eighth most commonly prescribed drug in the U.S., with some 52.3 million prescriptions written each year, according to the IMS research group’s Institute for Healthcare Informatics’ 2011 report. Its patent has expired, so generic versions of this drug have made it exceptionally affordable—often less than $25 per course even without insurance. Uncomplicated lower respiratory tract infections, such as the ones being tracked in the study, are often caused by viruses, which are not susceptible to antibiotics. But doctors are often not able to identify a virus immediately—especially in rushed and resource-strained clinical settings—leading physicians to often prescribe antibiotics as a cautionary measure.

This drug habit, however, might be doing more harm than good. “Using amoxicillin to treat respiratory infections in patients not suspected of having pneumonia is not likely to help and could be harmful,” Little said. “Overuse of antibiotics—which is dominated by primary care prescribing—particularly when they are ineffective, can lead to side effects—e.g. diarrhea, rash vomiting—and the development of resistance.”

The biggest hurdle might now be explaining to patients that these familiar drugs are not actually helping any better than a sugar pill would. “It is difficult to convince patients and their physicians against antibiotic use,” Schuetz wrote. But the new findings should help convince everyone to think twice before starting an antibiotic prescription.

This new study also underscores the natural lengthiness of lower respiratory tract infections. A person might be infected for more than a week before showing symptoms. The severe symptoms can, themselves, last for a week, and gradually improving symptoms can linger for much longer. So in the case of these ailments, perhaps time itself is the best treatment.

Katherine Harmon Courage About the Author: Katherine Harmon Courage is a freelance writer and contributing editor for Scientific American. Her book Octopus! The Most Mysterious Creature In the Sea is out now from Penguin/Current. Follow on Twitter @KHCourage.

The views expressed are those of the author and are not necessarily those of Scientific American.





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  1. 1. Allyn Woerpel 5:36 pm 12/19/2012

    my buddy’s sister makes $81/hour on the internet. She has been unemployed for 9 months but last month her pay check was $20262 just working on the internet for a few hours. Read more here….. BIT40.ℂOℳ

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  2. 2. JoshJansen 6:43 pm 12/19/2012

    Worse is the **** industry, force feeding ****** antibiotics because the animals stand knee-deep in their own waste all day and are fed a common type of seed, which they do not normally eat, instead of grass. This makes them more susceptible to disease, hence the need for antibiotics. Unfortunately, this irresponsible practice not only poisons the water supply downstream of them, but also causes E. coli to evolve resistances against the antibiotics.

    (this comment was censored in accordance with the veggie-libel laws we have in the USA.)

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  3. 3. Rikpar44 1:00 am 12/20/2012

    Spam/advertising crap is becoming more prevalent on SI blog comments. Can somebody at SI please put a stop to it!

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  4. 4. jgrosay 4:28 pm 12/20/2012

    Antibiotic resistance may be a very local fact, from inside an hospital to the community that it serves big differences exist, and Amoxicillin is an Anbiotic that is more tan 35 years old, so bacteria have had ample time to develop ways to escape its action, and the widespread use of Antibiotics as supplements in farm animals’ food is a source of resistances. In dealing with antibiotic use, two issues are important: how close do you start to take it since the beginning of the illness, and how adequate was the compliance with the presciption, and the adjustment of presciption to the approved ways for using it, and the time span the Antibiotc was used. Don’t forget that very serious ailments such as Endocarditis, Rheumatic fever, and Mastoidits that may lead to deafness or to death because of a meningitis are today rare events, and they were everyday problems just by the end of WWII.

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  5. 5. Mendrys 4:51 pm 12/20/2012

    Josh, what veggie-libel laws are you talking about? Give that I am reading your comment they certainly don’t seem to apply here. Your point is valid though.

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  6. 6. Sinus Infection 7:18 am 01/1/2013

    I repeatedly get prescribed with lots of antibiotics for sinus infection. The doctor forces me to take these,gosh. And too much Amoxicillin!

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  7. 7. tiny bird43 6:33 pm 01/13/2013

    I am currently taking amoxicillin 500mg 3times daily also azithromycin 250mg twice daily for what they call a chest infection.My own doctor was away when I became sick and could not get enough oxygen so was transported to the emergency department of the hospital by ambulance.x-ray was taken and I was given oxygen and fluid because of dehydration,I had a fever.I have taken quite a lot of this med.in the past and feel my own doctor would have given me a puffer with medication in it which she has done in the past.It seems to open the airway so I can breathe easier.Wish she had not been away.This is day4 and am still wheezing and coughing.

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  8. 8. SinupretSa 8:45 am 01/29/2013

    These days sinusitis requires you to go the extra mile if you want it to be treated effectively. There was once so much fame built around antibiotics but that flame needs to be controlled because overuse of antibiotics that are not effective does not just go wasted but it is not good for ones health.

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