Abstract
ObjectivesTo determine the benefits and harms of discontinuing unnecessary antibiotic therapy for uncomplicated respiratory tract infections (RTI) when antibiotics are considered no longer necessary. MethodsMulticentre, open-label, randomized controlled clinical trial in primary care centres from 2017 to 2020 (ClinicalTrials.gov, NCT02900820). Adults with RTIs—acute rhinosinusitis, sore throat, influenza or acute bronchitis—who had previously taken any dose of antibiotic for less than 3 days, which physicians no longer deemed necessary were recruited. The patients were randomly assigned in a 1:1 ratio to discontinuing antibiotic therapy or the usual strategy of continuing antibiotic treatment. The primary outcome was the duration of severe symptoms (number of days scoring 5 or 6 on a six-item Likert scale). Secondary outcomes included days with symptoms, moderate symptoms (scores of 3 or 4), antibiotics taken, adverse events, patient satisfaction and complications within the first 3 months. ResultsA total of 467 patients were randomized, out of which 409 were considered valid for the analysis. The mean (SD) duration of severe symptoms was 3.0 (1.5) days for the patients assigned to discontinuation and 2.8 (1.3) days for those allocated to the control group (mean difference 0.2 days; 95% CI –0.1 to 0.4 days). Patients randomized to the discontinuation group used fewer antibiotics after the baseline visit (52/207 (25.1%) versus 182/202 (90.1%); p 0.001). Patients assigned to antibiotic continuation presented a relative risk of adverse events of 1.47 (95% CI 0.80–2.71), but the need for further health-care contact in the following 3 months was slightly lower (RR 0.61; 95% CI 0.28–1.37). ConclusionsDiscontinuing antibiotic treatment for uncomplicated RTIs when clinicians consider it unnecessary is safe and notably reduces antibiotic consumption.
Highlights
Most acute uncomplicated respiratory tract infections (RTIs) are caused by viruses, and in otherwise healthy adults these infections are typically self-limiting [1]
Our results have shown that discontinuing an already initiated antibiotic treatment for uncomplicated RTI when the clinician considered that it was not indicated had no influence on the clinical outcomes of the patients
The duration of severe, moderate or any symptoms was similar in patients who continued or discontinued the antibiotic treatment, and both groups had a similar incidence of adverse effects
Summary
Most acute uncomplicated respiratory tract infections (RTIs) are caused by viruses, and in otherwise healthy adults these infections are typically self-limiting [1]. Many patients may seek attention in primary care, which often leads to inappropriate antibiotic prescription [2]. More than 60% of adults presenting with acute rhinosinusitis, acute bronchitis or sore throat are prescribed an antibiotic [2e4]. It is well known that inappropriate antibiotic use has negative implications, including a risk of subsequent infection with resistant organisms, Clostridioides difficile infections and adverse events [5]
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