Antibiotics May Not Impact Severity and Duration of Lower Respiratory Tract Infections, Study Finds

According to a large and prospective study on lower-respiratory tract infections, antibiotic use did not have any measurable effect on the duration or severity of coughs despite the presence of a bacterial infection.

Respiratory Tract Infections

Regarding respiratory tract infections, either the upper or lower tract can be affected. In the case of upper respiratory tract infections, symptoms typically include sore throat, common cold, ear infections, and sinus infections. According to Dan Merenstein, MD, the study's lead author and a family medicine professor at the School of Medicine at Georgetown University, these types of infections typically have well-established ways to discover whether antibiotics should be administered.

Lower respiratory tract infections are usually more dangerous. This is because roughly 3% to 5% of patients with these infections typically have pneumonia. However, not everyone can attain initial X-rays, which could be why physicians prescribe antibiotics without further evidence of bacterial infections.

Moreover, in the case of lower respiratory tract infections, patients typically expect antibiotics for cough, even if this may not help. Basic medications for symptom relief, alongside time, could resolve the majority of infections.

Antibiotics and Lower Respiratory Tract Infections

In the case of this study, the prescribed antibiotics were all commonly used and appropriate antibiotics for bacterial infection treatment. However, according to the analysis, for 29% of individuals administered antibiotics during their initial checkup, no significant effects were seen on the cough's duration and overall severity compared to those who did not take antibiotics.

Mark H. Ebell, MD, MS, the study's author and a professor at the University of Georgia's College of Public Health, explains that physicians know but may overestimate the bacterial lower tract infection percentage. Ebell adds that they may also overestimate their capacity to differentiate bacterial and viral infections.

In the study, 29% were given antibiotics, while just 7% received antiviral medications. However, most patients do not need antivirals, as medications are only available for treating two respiratory viruses: SARS-COV-2 and influenza. There are none for other virus types.

To distinguish whether a viral or bacterial infection was present beyond self-reported cough symptoms, the researchers were able to confirm pathogenic presence through lab tests for looking for microbiologic results that were classified as only viruses, only bacteria, no organism detected, or both bacteria and virus.

Crucially, among individuals who were confirmed to have a bacterial infection, the duration before illness resolution was the same for individuals who received and did not receive antibiotic medications: roughly 17 days.

Merenstein explains that they know that a cough could indicate a serious concern. It is the most prevalent illness-related reason for availing visits for ambulatory care. In fact, it accounts for over four million emergency room visits and nearly three million outpatient visits yearly.

Severe cough symptoms and treatment need further study. Merenstein adds that this could be done in a randomized clinical trial, as this recent study was observational.

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