The use of antibiotics in primary care is in the spotlight again after new research suggested that their use to treat persistent coughs (not caused by pneumonia) is "ineffective".

The European-wide study involved 2,061 patients with acute lower-respiratory-tract infections in whom pneumonia was not suspected, who were randomised to receive either amoxicillin or a placebo.

The findings, published in The Lancet, showed that neither the duration of those symptoms considered 'moderately bad' or worse or their severity differed between the two groups.

New or worsening symptoms were found to be significantly less common in patients receiving amoxicillin versus those in the control arm. But, on the other hand, cases of nausea, rash, or diarrhoea were more common in patients taking the antibiotic. 

Based on their data, the researchers have concluded that when pneumonia is not suspected, "amoxicillin provides little benefit for acute lower-respiratory-tract infection in primary care both overall and in patients aged 60 years or more, and causes slight harms".

The findings are particularly pertinent given the recent focus on reigning in the widespread use of antibiotics in primary care. 

Problems with overuse

"Overuse of antibiotics, which is dominated by primary care prescribing, particularly when they are ineffective, can lead to side effects such as diarrhoea, rash, vomiting and the development of resistance," said lead study author Paul Little, Professor of Primary Care Research at the University of Southampton.

“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," he noted.

"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 the other patients,” added Philipp Schuetz from the University of Basel in Switzerland.

Last month Chief Medical Officer Professor Dame Sally Davies warned that antibiotics are losing their effectiveness "at a rate that is both alarming and irreversible", and she urged patients and prescribers "to think about the drugs they are requesting and dispensing".