ArticleAnnals of family medicine
Risks and benefits associated with antibiotic use for acute respiratory infections: a cohort study.
Article in Annals of family medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 3 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed, 3 syntheses or guidelines pooled it, 49 citations in OpenAlex.
- A systematic review and meta-analysis on diagnostic accuracy of point-of-care C-reactive protein devices for acute respiratory tract infections.Infection · 2026Pooled it
- Biomarkers as point-of-care tests to guide prescription of antibiotics in people with acute respiratory infections in primary care.The Cochrane database of systematic reviews · 2022Pooled it
- Comparison of pediatric and adult antibiotic-associated diarrhea and Clostridium difficile infections.World journal of gastroenterology · 2016Pooled it
- Results from a Patient-Based Health Education Intervention in Reducing Antibiotic Use for Acute Upper Respiratory Tract Infections in the Private Sector Primary Care Setting in Singapore.Antimicrobial agents and chemotherapy · 2017Trial
- Evidence-to-Recommendation Framework for 2026 ACE Clinical Guideline on upper respiratory tract infections - rational antimicrobial use.Singapore medical journal · 2026Article
- Primary Care Antibiotic Prescribing and Infection-Related Hospitalisation.Antibiotics (Basel, Switzerland) · 2023Review
- Descriptive Analysis of Adverse Drug Reactions Reports of the Most Consumed Antibiotics in Portugal, Prescribed for Upper Airway Infections.Antibiotics (Basel, Switzerland) · 2022Article
- The diagnosis of respiratory disease in children using a phone-based cough and symptom analysis algorithm: The smartphone recordings of cough sounds 2 (SMARTCOUGH-C 2) trial design.Contemporary clinical trials · 2021Article
- Article
- Systematic Review on the Impact of Guidelines Adherence on Antibiotic Prescription in Respiratory Infections.Antibiotics (Basel, Switzerland) · 2020Review
- Impact of antimicrobial stewardship fee on prescribing for Japanese pediatric patients with upper respiratory infections.BMC health services research · 2020Observational
- Article
- Over prescribing of antibiotics for acute respiratory tract infections; a qualitative study to explore Irish general practitioners' perspectives.BMC family practice · 2019Article
- Antibiotic use for acute respiratory tract infections (ARTI) in primary care; what factors affect prescribing and why is it important? A narrative review.Irish journal of medical science · 2018Review
- Severe Drug-Induced Agranulocytosis Successfully Treated with Recombinant Human Granulocyte Colony-Stimulating Factor.Case reports in medicine · 2018Article
- Association of Adverse Events With Antibiotic Use in Hospitalized Patients.JAMA internal medicine · 2017Article
- Knowledge, attitudes and practices towards antibiotic use in upper respiratory tract infections among patients seeking primary health care in Singapore.BMC family practice · 2016Article
- Comparative effectiveness of three anxiolytics for acute respiratory infections: antibiotics, C-reactive protein point-of-care testing, and improved communication.Journal of general internal medicine · 2015Article
- Antimicrobial stewardship - can we afford to do without it?British journal of clinical pharmacology · 2015Article
- Antibiotic stewardship.Clinical medicine (London, England) · 2013Review
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
Abstract
purposeAntibiotics are frequently prescribed for acute nonspecific respiratory infections (ARIs), presumably to avoid small risks of progression to serious bacterial illness. However, even low risks of associated adverse drug events could result in many such events at the population level. Our objective was to assess the risks and benefits of antibiotic use in a cohort of patients with ARIs, comparing outcomes of patients who were prescribed antibiotics with outcomes of patients not receiving antibiotics.
methodsWe used a June 1986 to August 2006 cohort of adult patients with ARI visits from a UK primary care database. Exposure was an antibiotic prescribed with the visit. Primary outcomes were hospitalization within 15 days for (1) severe adverse drug events (hypersensitivity, diarrhea, seizure, arrhythmia, hepatic or renal failure), and (2) community-acquired pneumonia.
resultsThe cohort included 1,531,019 visits with an ARI diagnosis; prescriptions for antibiotics were given in 65% of cases. The adjusted risk difference for treated vs untreated patients per 100,000 visits was 1.07 fewer adverse events (95% CI, -4.52 to 2.38; P = .54) and 8.16 fewer pneumonia hospitalizations (95% CI, -13.24 to -3.08; P = .002). The number needed to treat to prevent 1 hospitalization for pneumonia was 12,255.
conclusionsCompared with patients with ARI who were not treated with antibiotics, patients who were treated with antibiotics were not at increased risk of severe adverse drug events and had a small decreased risk of pneumonia hospitalization. This small benefit from antibiotics for a common ambulatory diagnosis creates persistent tension; at the societal level, physicians are compelled to reduce antibiotic prescribing, thus minimizing future resistance, whereas at the encounter level, they are compelled to optimize the benefit-risk balance for that patient.
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Registered trials
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