Wednesday, October 24, 2007

Let’s get grandma on some antibiotics before this goes into pneumonia

The guidelines and the experts tell doctors to say no. But just when it looks like they’re starting to listen (the rate of antibiotic prescriptions for respiratory infections seems to be going down) comes this study in BMJ. Although NNTs were very high for preventing mastoiditis and quincy after ototis and sore throat, respectively, they were low for preventing pneumonia after bronchitis, particular in the elderly (39!).

What is already known on this topic
Guidelines based on randomised controlled trials recommend that antibiotics should not be prescribed for upper respiratory tract infection, sore throat, or otitis media.

Chest infections are divided into acute bronchitis (antibiotics not recommended) and pneumonia (antibiotics recommended).

What this study adds
Antibiotics reduce the risk of mastoiditis after otitis media, quinsy after sore throat, and pneumonia after upper respiratory tract infection but over 4000 courses of antibiotics are needed to prevent one complication.

Conversely, the risk of pneumonia in those presenting with chest infection is high, particularly in elderly patients, and can be substantially reduced by the use of antibiotics.

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