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Well-known antibiotic amoxycillin found to be ineffective cough treatment

An antibiotic commonly prescribed for infections including coughs and bronchitis is ineffective at relieving symptoms, and…

Antibiotic amoxycillin, widely prescribed to patients with a cough, has been found to be largely ineffective. Sergio Alvarez

An antibiotic commonly prescribed for infections including coughs and bronchitis is ineffective at relieving symptoms, and may actually be harmful if overused, according to a new European study.

The study of 2,061 adults, published in The Lancet Infectious Diseases, found patients prescribed amoxycillin did not recover more quickly or have significantly fewer symptoms than those who received no medication.

“Using amoxycillin to treat respiratory infections in patients not suspected of having pneumonia is not likely to help and could be harmful,” said Professor Paul Little from the University of Southampton in the UK who led the research.

He added that overuse of antibiotics could also lead to side effects such diarrhoea, rash, and vomiting, in addition to the development of resistance.

The study shows that unless a patient has pneumonia, the risk of side-effects outweighs the small benefit of treatment with the antibiotic, said Dr Trent Yarwood, infectious diseases physician at Queensland Health.

“Thirty patients would need to be treated to prevent one having a worsening of their symptoms, but only 21 would need to be treated to result in an antibiotic-related side-effect (rash, nausea or diarrhoea),” Dr Yarwood said.

However Dr Michael Tam, GP and lecturer in primary care at the University of New South Wales, said the study doesn’t mean that antibiotics should never be used.

“For the most part, these findings confirm what we think to be best practice for lower respiratory tract infections that are not suspected to be pneumonia,” Dr Tam said.

“For instance, the Australia based “eTG Complete” guidelines already recommend against the use of antibiotics for acute bronchitis.”

Dr Tam said, as always, an individual seeking care should have a discussion with their GP on what would be the most appropriate treatment for them, at the time, in their specific situation.

“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,” Professor Little 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,” said Dr Philipp Schuetz from the Kantonsspital Aarau in Switzerland.

“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,” Dr Schuetz said.

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8 Comments sorted by

  1. Luke Weston

    Physicist / electronic engineer

    Well, we already know that antibiotics are inappropriate and ineffective in most coughs, assuming that the cough is related to a viral infection such as common cold or 'flu which it most commonly would be.

    Or is it implied that this research found amoxycillin to be ineffective at resolving coughs related to a *bacterial* infection?

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    1. Trent Yarwood

      Infectious Diseases Physician, Associate Lecturer at University of Queensland

      In reply to Luke Weston

      it was all patients with symptoms of a "lower respiratory tract infection" (cough + sputum) who didn't have clinical features of pneumonia. Many of these will have been bronchitis (which is usually viral) and as Dr Tam pointed out, Australian guidelines don't recommend antibiotics for.

      In practice however, patients commonly do get prescribed antibiotics for this presentation; this study confirms that it's not helpful.

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  2. Ken Harvey

    Adjunct Associate Professor, School of Public Health and Preventive Medicine at Monash University

    The TGA has recently registered a complementary medicine; KALOBA® (ARTG: 193170, Schwabe EPs 7630, Pelargonium sidoides) an oral liquid for “for the treatment of acute bronchitis and sinusitis".

    If a product is registered on the ARTG (as distinct from listed) its means that the TGA has satisfied itself that there is good evidence of efficacy, for example see: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2855831/ and http://www.ncbi.nlm.nih.gov/pubmed/20387996.

    Acute bronchitis and rhinosinusitis…

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Ken Harvey

      I suspect a lot of coughs are secondary to post-nasal drip from rhinosinusitis - largely viral, but the sinuses can develop secondary infection. One good therapy is to clear the sinuses and reduce the secretions with a combination of inhalations, saline washes and vasoconstrictor sprays - tackle the cause locally, drain the sinuses and the infection will generally resolve.

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  3. George Naumovski

    Online Political Activist

    Eventually the viruses build up an immunity to medication. All those cold & flu medications do nothing to help you; all those allergies pills do nothing to help you, but it does help the pharmaceutical companies increase their profits! Research needs to be done and cues can be made but only if it is owned by the people and not by the corporations. If this does not happen then the placebos will be kept given to us.

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    1. Sue Ieraci

      Public hospital clinician

      In reply to George Naumovski

      George - antibiotics are for bacteria, not viruses.

      Cold, flu and anti-allergy pills actually can do a lot to relieve the headache, sinus and throat discomfort, nasal congestion and dripping that make a cold so miserable. Better people use these symptomatic treatments than antibiotics for a viral illness.

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  4. John Kelmar

    Small Business Consultant

    As an ex Medical Rep in the early 1970's we all knew that amoxycillin was not to be used in an ad hoc fashion, but getting that message across to some doctors was impossible. These doctors always treated Medical Reps with disdain because they had studied for 6 years, compared to medical reps who usually had a 3 year degree. However the doctor's had to cram a great deal of knowledge into their 6 years, whilst the Medical Reps had specialised knowledge of the products they were selling.

    Now that I am in my 60's, I still am wary of doctors (GPs) younger than myself, especially those in their 20's, as their knowledge and experience is fragmented with a huge range of symptoms and medications allowing little time to gain superior knowledge in specialised areas. They also need to LISTEN to their patients more carefully as they have greater experience about their own bodies.

    Doctors need to be re-examined every five years to ensure that their knowledge is appropriate and up to date.

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