The BMJ's video: Reduced antibiotic prescribing for self limiting respiratory tract infections

Read the full open access research: http://www.bmj.com/content/354/bmj.i3410 Concern is growing that the widespread and sometimes unnecessary use of antibiotics is leading to the development of antimicrobial drug resistance and potentially to infections caused by resistant organisms that are difficult to treat.Reducing the inappropriate use of antibiotics, as well as ensuring that they can be used when needed, represent important components of a strategy to control infectious diseases. Nevertheless, around 36% of common colds continue to be treated with antibiotics, as do 40% of episodes of sore throat, 70% of otitis media, and 90% of sinusitis. Clinical concern that reducing antibiotic use might increase the risk of complications following RTIs might be realistic. Evidence from clinical trials suggests that antibiotics may reduce the risk of suppurative complications of RTIs, but the more serious complications are generally too rare to evaluate precisely in randomised studies. So in this study, the authors set out to determine whether the incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre’s syndrome is higher in general practices that prescribe fewer antibiotics for self limiting respiratory tract infections (RTIs). They conclude that general practices that adopt a policy to reduce antibiotic prescribing for RTIs might expect a slight increase in the incidence of treatable pneumonia and peritonsillar abscess. No increase is likely in mastoiditis, empyema, bacterial meningitis, intracranial abscess, or Lemierre’s syndrome. Even a substantial reduction in antibiotic prescribing was predicted to be associated with only a small increase in numbers of cases observed overall, but caution might be required in subgroups at higher risk of pneumonia.