Joint Decision Should Determine Antibiotic Use for Acute Respiratory Tract Infections

A recent Cochrane Review suggests that primary care doctors should involve patients in their decision regarding the antibiotics use for acute respiratory tract infections.

The holiday 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.

Several primary 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 willingly.

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.

Reference:

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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.

Source-Medindia