A recent Cochrane Review
suggests that primary care doctors should involve patients in their decision
regarding the antibiotics use for acute respiratory tract infections.
season of winter is also marked by an increase in respiratory tract infections like middle ear infections, acute cough, sore throat, bronchitis and sinusitis
. A quick visit to the primary care
physician and you are back home with a course of antibiotics and happy that they will help you recover very fast. However, there are some aspects of acute respiratory infections
and antibiotics that you may not be aware:
- Many times, respiratory infections are caused by viruses and
not bacteria. Viral infections usually resolve on their own, only with
conservative treatment like enough rest and warm drinks.
- Patients may feel that if they take antibiotics, they will
recover faster. However, in several cases, the time to recover will remain
the same irrespective of whether you use an antibiotic or not.
- In some cases, a runny nose may not be due to an infection but
a sign of an allergy. These patients need anti-allergy medications and not antibiotics.
- Unnecessary use of antibiotics results in higher cost for the
patient and more exposure to side effects especially in situations where
they may not be needed at all.
- Excessive antibiotic use also has an implication for the
society in general. If bacteria are exposed repeatedly to antibiotics,
especially if the course is not completed, there is a high chance they
will soon be resistant to them. Thus, the antibiotics may not be effective
at times when they are really needed.
care doctors treat patients with antibiotics fearing that they may get worse.
Or, since the patient expects antibiotics, they prescribe them knowing that if
they don't, the patient will only go to the next doctor who will prescribe them
‘Antibiotic resistance can be prevented by shared decision between doctor and patient for acute respiratory infection.’
Thus, the best
way out is for the primary care physician and the patient to discuss together
and decide if an antibiotic will be necessary or not, and the pros and cons of taking antibiotics
A new study from
the Cochrane library evaluated several studies where antibiotics for
respiratory tract infections were prescribed based on shared decision making.
The study analyzed 10 published studies which covered over 1100 primary care
doctors and around 492,000 patients. The doctors spent time discussing the use
of the antibiotic for the infection with the patient and a joint decision was
taken whether it was really necessary. In some studies, patients were given
written information on the use of antibiotics
, so that they could discuss it during the consultation.
The study found
that following shared decision making, antibiotic use reduced from 47% to 29%
within 6 weeks, based on analysis of 8 included studies. At the same time,
lesser antibiotics did not translate into increased number of repeated
consultations for the same illness or reduced patient satisfaction. Thus,
shared decision making could possibly have a huge impact on reducing antibiotic resistance
As in the case
of respiratory tract infections, communication between a doctor and a patient
is very important for the successful treatment of any condition.
1. Coxeter P, Del Mar CB, McGregor L, Beller EM, Hoffmann TC. Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. Cochrane Database of Systematic Reviews 2015, Issue 11. Art. No.: CD010907. DOI: 10.1002/14651858.CD010907.pub2.