Antibiotics' effect on chest infections queried

Antibiotics' effect on chest infections queried

Posted: Thu 27/12/2012 by Deborah Condon www.irishhealth.com

Chest infections are very common at this time of year. However, a new study has found that an antibiotic commonly prescribed for some of these infections does not work, even in older patients.

The study focused on common lower respiratory tract infections (LRTI), such as bronchitis and the effect of the antibiotic, amoxicillin.

According to UK scientists, LRTIs are one of the most common acute illnesses seen by GPs. While most of these infections are thought to be caused by viruses - which antibiotics have no effect on - the use of the drugs in treating them is a topic of major debate. To date, research results have been conflicting.

The team from the University of Southampton looked at over 2,000 adults with acute, uncomplicated LRTIs from 12 European countries, including England, Wales, Germany, Sweden Spain and Poland.

The participants were randomly assigned to receive either amoxicillin or a placebo three times a day for seven days. They were monitored throughout.

The study found that there was little difference in the duration or severity of the symptoms between the two groups. This was true even for patients over the age of 60.

While more patients in the placebo group reported new or worsening symptoms, just two from that group, along with one from the antibiotic group, needed to be hospitalised because of the LRTI.

Furthermore, patients in the antibiotic group reported more side-effects, such as diarrhoea, nausea and rash, than those in the placebo group.

"Our results show that most people get better on their own. But, given that a small number of patients will benefit from antibiotics, the challenge remains to identify these individuals," commented Prof Paul Little of the University of Southampton.

He added that using amoxicillin to treat respiratory infections in patients not suspected of having pneumonia ‘is not likely to help and could be harmful', particularly if it leads to antibiotic resistance.

Details of these findings are published in the journal, The Lancet Infectious Diseases.

Irish Health

New British and American guidelines for the antibiotic prophylaxis of infective endocarditis: do the changes make sense? A critical review.

New British and American guidelines for the antibiotic prophylaxis of infective endocarditis: do the changes make sense? A critical review.

Curr Opin Infect Dis. 2008 Apr

Shanson D.
Department of Medical Microbiology, Great Ormond Street Hospital for Children, London, UK.

PURPOSE OF REVIEW: The British Society for Antimicrobial Chemotherapy and the American Heart Association have radically revised their guidelines for the antibiotic prophylaxis of endocarditis. This review discusses the evidence behind the most controversial changes and considers possible future developments.

RECENT FINDINGS: The new guidelines emphasize good oral hygiene for preventing viridans streptococcal endocarditis. Antibiotic prophylaxis for dental procedures is only recommended for patients with the highest-risk cardiac conditions. American Heart Association guidelines no longer recommend prophylaxis for urological and gastrointestinal procedures.

SUMMARY: While only up to 6% of endocarditis cases may be prevented by antibiotic prophylaxis there is controversy as to what to recommend for the individual cardiac patient undergoing a given procedure. The new guidelines about dental prophylaxis are based on epidemiological studies that failed to include sufficient subjects undergoing specific interventions. When considering viridans streptococcal rather than total bacteraemia rates, asserting that the prevalence of bacteraemia after invasive dental procedures is similar to that after toothbrushing may be incorrect. The British Society for Antimicrobial Chemotherapy report probably overestimates the risk of fatal anaphylaxis after an oral dose of amoxicillin. In contrast, the American Heart Association guidelines comment on the absence of any reports of fatal anaphylaxis associated with the antibiotic prophylaxis of endocarditis.

Lippincott, Williams & Wilkins