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A new study by researchers in the UCL Centre for Infectious Disease Epidemiology (CIDE) has shown that antibiotics are not justified to reduce the risk of complications after upper respiratory tract infection, sore throat, or ear infection. The paper, published by the British Medical Journal, does provide evidence that antibiotics do substantially cut the risk of pneumonia after chest infection, particularly in elderly people.
Most antibiotics are prescribed by GPs, and mostly for common respiratory tract infections, such as tonsillitis, sinusitis and the common cold.
The research team, led by Dr Andrew Hayward, set out to find whether there was a higher rate of complications resulting in patients who had not been prescribed antibiotics, compared to those who had taken them. The data was taken from 162 practices on the UK General Practice Research Database from 1991 to 2001. Risk of serious complications in the month after diagnosis were recorded: mastoiditis – infection of the mastoid bone of the skull – after ear infection, quinsy – an abscess at the back of the throat – after sore throat, and pneumonia after upper respiratory tract infection and chest infection. Serious complications were rare after upper respiratory tract infections, sore throat, and ear infection.
In contrast, the risk of pneumonia after chest infection was high, particularly in elderly people, and was substantially reduced by antibiotic use. The risks were not appreciably different in smokers, those with chronic respiratory disease, or those with cardiac disease. Dr Hayward concluded: “General practitioners should not base their prescribing for sore throat, ear infection, or upper respiratory tract infections on a fear of serious complications.
All the methods require some initial training on handling this type of medication – but with practice, and reference to the nurses, it can usually be carried out very successfully.
After standard antibiotics failed to shift a severe lung infection, Jane Allan was more than happy when her GP suggested she move onto a stronger antibiotic, ciprofloxacin. Jane, who suffers from asthma, was a hospital pharmacist and remembered the excitement when ciprofloxacin became available in the early Nineties. Yet Jane now blames the drug for the litany of health problems she suffers, including widespread muscle pain and weakness and severe fatigue. Jane read the patient information leaflet and found serious side-effects, including those she was experiencing. Jane went to AE and said she thought she was having an adverse drug reaction, but the doctor suggested she see her GP, who prescribed painkillers. It’s one of a family of antibiotics which are known as fluoroquinolones (others include levofloxacin and moxifloxacin). Fluoroquinolones are broad-spectrum antibiotics, meaning they work against a large number of bacteria, such as salmonella, E.coli, gonorrhoeae and pseudomonas (bacteria that can cause serious lung infections).

The antibiotics were a godsend when they were introduced, as other commonly used antibiotics, such as penicillin, ceased to work for everyday infections such as urinary tract and skin problems. The fact that fluoroquinolones could be given in tablet form, rather than intravenously as was the case with many other strong antibiotics, added to their popularity. At their peak, prescriptions for fluoroquinolones from GPs and other community practitioners reached 1.35 million a year, although numbers began to fall as the drugs were associated with the hospital superbugs MRSA and clostridium difficile. But in 2014 there were still more than 750,000 fluoroquinolones dispensed in the community (more are used in hospitals). A recent study in the BMJ found fluoroquinolones may contribute to aortic tears and aneurysms (damage and rupture of the aorta, the main artery in the body), which can result in life-threatening bleeding.
More recently, a 2012 study published in the journal JAMA showed people who’d had the drugs had a five-fold increased risk of retinal detachment, which can lead to blindness.
It’s thought the side-effects may be the result of the drugs degrading collagen, a protein found in muscles, skin and bones and which acts as a scaffolding structure for strength and stability.
Dr Beatrice Golomb, a professor of medicine at the University of California, recently reported in the journal BMJ Open the experiences of four formerly healthy patients who reported widespread symptoms, including joint and muscle pain, brain fog, mood problems, concentration difficulties, memory problems, anxiety and confusion after a course of fluoroquinolones. The FDA said that for patients with sinusitis, bronchitis or uncomplicated urinary tract infections, the risks of the drugs outweighed the benefits, and they should not be given unless there are no alternative treatments.
Here, Public Health England says ciprofloxacin should be used only for treating acute inflammation of the prostate gland or a kidney infection. The UK’s drug watchdog, the Medicines and Healthcare products Regulatory Authority (MHRA), says 5,962 adverse drug reactions have been reported for fluoroquinolones in the UK since 1990, with more than 4,500 for ciprofloxacin, the most frequently prescribed fluoroquinolone (although this may be seriously under-reported). Dr David Healy, professor of psychiatry at the University of Bangor, and director of the patient drug safety group RxISK, says serious fluoroquinolone side-effects have been reported since they were introduced.
A spokeswoman for the MHRA said they will work with European regulators to consider any new evidence on fluoroquinolones, but added it was important that patients should not stop the drugs and should speak to their doctors. While she is convinced the antibiotics were to blame for her ill-health, Jane Allan’s battle for diagnosis has been protracted. She’s joined a newly formed online support group, Quinolone Antibiotic Toxicity Support UK, which has more than 35 members. She wants more prominent warnings about the side-effect risks from fluoroquinolones and greater awareness among prescribers and pharmacists. Recommendations not to prescribe antibiotics for these conditions are based on concerns about the development of resistance and evidence of minimal benefit for the patient. They examined 3.36 million cases of respiratory tract infection to find out how many had suffered from serious complications.

The team recorded how many cases developed serious complications of common respiratory tract infections comparing thosewho were prescribed antibiotics and those who were not.
Without an antibiotic prescription, four per cent of patients aged 65 or over were diagnosed with pneumonia in the month after diagnosis, compared to 1.5 per cent of those who were treated with an antibiotic.
Jane has since come across others with similar long-term effects believed to be linked to these antibiotics. Another black box warning was added to ciprofloxacin in 2013, saying it may worsen symptoms of a rare muscle weakness condition, myasnthia gravis.
Food and Drug Administration (FDA) issued new advice on fluoroquinolones, saying the drugs ‘are associated with disabling and potentially permanent serious side-effects that can occur together. After six weeks, her GP referred her to a rheumatologist who ruled out rheumatoid arthritis. However, many chest infections in otherwise healthy people do not need antibiotic medicines and get better quite quickly.
The continued high rate of antibiotic prescription may be put down to patient expectation and fear of complications arising from the infection.
But much less than a spell in hospital of perhaps 14 days which may be the only alternative.
If you feel very unwell then you should see a doctor urgently to see what treatment you need.
The symptoms of acute bronchitis (infection of the large airways in the lungs (bronchi)) and pneumonia (a serious lung infection) may be similar, but pneumonia symptoms are usually more severe. Sometimes the bacterium that is causing the pneumonia (a serious lung infection) is resistant to the first antibiotic.
Some contain paracetamol, so be careful not to take more than the maximum safe dose of paracetamol if you are already taking paracetamol tablets.
As bronchitis is usually caused by a virus, your recovery will rarely be helped by taking antibiotics. Taking antibiotics unnecessarily for bronchitis can cause side-effects and do more harm than good.

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