Amoxicillin appears to be ineffective for cough

Taken from The Lancet – by Bruce Sylvester – Patients with cough treated with amoxicillin do not recover significantly more quickly or have significantly fewer symptoms than other patients, researchers reported on Dec. 18 in The Lancet.

Professor Paul Little from the University of Southampton in the UK who led the research said, “Using amoxicillin to treat respiratory infections in patients not suspected of having pneumonia is not likely to help and could be harmful. Overuse of antibiotics (which is dominated by primary care prescribing), particularly when they are ineffective, can lead to side effects (eg, diarrhoea, rash, vomiting) and the development of resistance.”

The investigators enrolled 2061 adults with acute uncomplicated lower respiratory tract infection from primary care practices in 12 European countries (England, Wales, Netherlands, Belgium, Germany, Sweden, France, Italy, Spain, Poland, Slovenia, and Slovakia). They randomized the subjects to receive either amoxicillin or a placebo three times a day for 7 days.

Doctors assessed symptoms at baseline, and subjects kept a daily symptom diary.

The investigators found little difference in severity or duration of symptoms between the two groups. Notably, this was also true for older, generally healthy patients (60 years and older).

While significantly more subjects in the placebo group experienced new or worsening symptoms (19.3% vs 15.9%), the number of subjects needing to be treated to prevent one case of worsening symptoms was high (30).

Also, subjects using antibiotics reported significantly more side effects, including nausea, rash, and diarrhoea, than those given placebo (28.7% vs 24%).

According to Dr. Little, “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.”*

In an accompanying commentary, Philipp Schuetz, MD, of Kantonsspital Aarau in Aarau, Switzerland  said, “Little and colleagues have generated convincing data that should encourage physicians in primary care to refrain from antibiotic treatment in low-risk patients in whom pneumonia is not suspected. Whether this one size-fits-all approach can be further improved remains to be seen. 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 and the development of resistance in other patients.”