Antibiotics: Can I Have More Please? Part 3

Looking back at past meetings which I've attended over the years, there's been a dramatic reduction in the push by Big Pharma for antibiotics aimed at upper respiratory infections.  Most recently, the American Academy of Family Physicians has added to the growing list of what not to do (no antibiotics early on in the course of an acute sinus infection) as summed up by the American Board of Internal Medicine Foundation's Choosing Wisely campaign.  This conservative approach is supported by a study published in January concluding that a typical cough illness lasts an average of 18 days.

Well, we've long used the color of phlegm as a gauge to determine whether to prescribe antibiotics or not: clear implied viral origin while discolored phlegm suggested bacterial origin requiring antibiotics.  WRONG!  It turns out that phlegm color has nothing to do with infectious etiology.  It just sounded good.  In fact, in a randomized double-blind, placebo-controlled trial published three days ago in the British Medical Journal, the authors concluded that neither ibuprofen nor amoxicillin-clavulanate shortened the duration of cough or production of discolored phlegm due to an acute bronchitic infection compared to placebo.

Granted those 136 randomized to ibuprofen coughed an average of 9 days (range 8-10) compared to those 137 randomized to amoxicillin-clavulanate or 143 to placebo who coughed an average of 11 days (range 10-12 vs 8-14) but this was not considered statistically significant.  More important, those who received an antibiotic had 2 to 4 times the risk of side effects compared to those randomized to the anti-inflammatory or placebo.

Bottom line, antibiotics aren't useful in treating most upper respiratory infections.  Your doc is actually doing you a favor by trying to talk you out of your request for antibiotics while the next doc you see is doing you a disservice by quickly acquiescing to your request just to get you out of his/her office that much more quickly.  In other words, be careful what you ask.  

Antibiotics: Can I Have More Please? Part 2

Antibiotics: Can I Have More Please?

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