Antibiotics don’t reduce risk of dying from respiratory infections: study

By Mark Waghorn via SWNS

Antibiotics don't reduce the risk of dying from common respiratory infections, according to new research.

Doctors should administer them more responsibly - with particular restrictions on their use against viral bugs, say scientists.

The study of more than 2,000 hospitalized adults adds to evidence they are unlikely to save lives.

Lead author Dr. Magrit Jarlsdatter Hovind, of the University of Oslo, said: "Lessons from the Covid-19 pandemic suggest antibiotics can safely be withheld in most patients with viral respiratory infections, and that fear of bacterial co-infections may be exaggerated.

"Our new study adds to this evidence, suggesting that giving antibiotics to people hospitalized with common respiratory infections is unlikely to lower the risk of death within 30 days.

"Such a high degree of potentially unnecessary prescribing has important implications given the growing threat of antimicrobial resistance."

More than 1.2 million people died worldwide in 2019 from infections caused by bacteria resistant to antibiotics - more than the annual death toll from malaria or AIDS.

The World Health Organization (WHO) says the crisis is one of the biggest threats facing mankind - with the prospect of medicine returning to the "dark ages."

The overuse of antibiotics in recent years means they are becoming less effective against serious infections.

People are dying from common, previously treatable illnesses because the bacteria that cause them have become resistant to treatment.

UK health has recently described antimicrobial resistance (AMR) as a "hidden pandemic" that could emerge in the wake of Covid-19.

Respiratory infections are the most common reason for administering antibiotics - accounting for around ten percent of the global disease burden.

Many are viral and do not require or respond to them. But concerns about bacterial co-infection often lead to "precautionary prescribing."

In some countries, antibiotics were prescribed for around 70 percent of Covid patients, even though their use was only justified in about one in ten cases.

Dr. Hovind and colleagues analyzed their impact on 2,111 adults admitted to Akershus University Hospital, Norway, with flu, coughs or colds or severe Covid between 2017 and 2021.

Antibiotic therapy was initiated soon after arrival in over half. A further 168 patients were given them later during hospitalization. In total, 1,321 (63%) received the drugs.

Overall, 168 (8%) patients died within 30 days - 119 patients of whom were prescribed antibiotics at admission and 27 later. The other 22 were not given them.

The antibiotics groups were actually twice as likely to die within 30 day. Risk of mortality increased by three percent for each day of therapy compared with those not given antibiotics.

Dr. Hovind explained: "Although the analyses were adjusted for disease severity and underlying disease, this paradoxical finding may still be due to an antibiotic prescription pattern where the sicker patients and those with more underlying illnesses were both more likely to get antibiotics and to die."

Her team also took into account virus type, sex and age.

She added: "Reducing the use and duration of in-hospital antibiotic therapy in patients with viral respiratory infections would reduce the risk of side effects from antibiotic exposure and help tackle the growing threat of antibiotic resistance.

"However, more robust evidence is needed from prospective randomized trials to determine whether patients admitted to hospital with viral respiratory infections should be treated with antibiotics."

Previous research has found most deaths from AMR are caused by lower respiratory infections, such as pneumonia, and bloodstream infections, which can lead to sepsis.

The hospital superbug MRSA (methicillin-resistant Staphylococcus aureus) is particularly deadly, while E. coli, and several other bacteria, are also linked to high levels of drug resistance.

Dr. Hovind presented the study at a European Congress of Clinical Microbiology & Infectious Diseases meeting in Copenhagen.