Study Suggests Restrictive Antibiotic Strategy for Respiratory Infections May Be Necessary
According to a recent study, prescribing antibiotics to adults hospitalized with common viral respiratory infections such as influenza is unlikely to reduce the risk of dying.
The findings suggest that a more restrictive antibiotic strategy for viral respiratory infections may be necessary.
Dr. Magrit Jarlsdatter Hovind, the lead author of the study from Akershus University Hospital and the University of Oslo, Norway, states that the Covid-19 pandemic has taught us that antibiotics can be safely withheld in most patients with viral respiratory infections, and the fear of bacterial co-infections may be exaggerated.
The study adds to this evidence, indicating that “giving antibiotics to people hospitalised 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.”
Around 10% of the world’s disease burden comes from respiratory infections, and antibiotics are the most frequently prescribed treatment. However, many of these infections are viral and do not respond to antibiotics, leading to unnecessary prescribing due to concerns about bacterial co-infections. During the COVID-19 pandemic, concerns about bacterial co-infections led to widespread use of antibiotics in hospitals and communities, with studies reporting that up to 70% of COVID-19 patients were prescribed antibiotics, despite being justified in only 1 in 10 cases.
Norwegian researchers conducted a retrospective analysis to evaluate the impact of antibiotic therapy on mortality in 2,111 adults admitted to Akershus University Hospital with positive nasopharyngeal or throat swab results for respiratory syncytial virus (RSV; 20%, 429/2,111), influenza virus (H3N2, H1N1, influenza B; 44%, 935/2,111), or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; 35%, 747/2,111) between 2017 and 2021.
During hospitalization, routine tests were conducted on patients with respiratory infections, including blood cultures and nasal or throat swabs to identify common viral and bacterial pathogens. This analysis excluded patients with a confirmed bacterial pathogen or those with other infections that required antibiotic therapy. Of the 2,111 patients admitted to the hospital with viral respiratory infections, 55% (1153/2,111) received antibiotic therapy at admission, while 168 patients received antibiotics later during their hospital stay. In total, 63% (1,321/2,111) of patients with respiratory infections received antibiotics during their hospitalization.
According to the study, 8% of the patients died within 30 days. Among them, 119 patients had been prescribed antibiotics at admission, 27 patients received antibiotics later during their hospital stay, and 22 patients were not prescribed antibiotics. Analyses that were adjusted for virus type, sex, age, severity of disease, and underlying illnesses showed that patients who were given antibiotics at any time during their hospital stay were twice as likely to die within 30 days than those who were not given antibiotics. The risk of mortality also increased by 3% for each day of antibiotic therapy, compared with those not given antibiotics. Interestingly, the study found that initiating antibiotics at hospital admission was not linked to an increased risk of death within 30 days.
Dr. Hovind explains that despite adjusting for disease severity and underlying conditions, the paradoxical finding of increased mortality among patients receiving antibiotics may be attributed to a prescription pattern where sicker patients and those with more underlying illnesses were more likely to receive antibiotics and have a higher risk of death.
Dr. Hovind futher notes limiting the use and duration of antibiotics in hospitalised patients with viral respiratory infections can minimize the risk of harmful side effects and contribute to the global fight against antibiotic resistance.
However, further prospective randomized studies are required to provide more substantial evidence regarding the necessity of prescribing antibiotics to individuals admitted with viral respiratory infections.
The study has some limitations, as it is an observational study that cannot establish causation. Despite adjusting for virus type, age, sex, and underlying illnesses, the researchers recognize that other unreported factors such as smoking and socioeconomic background may have influenced the outcome.
Furthermore, the absence of data for biochemistry/biomarkers like white blood cell (WBC), C-reactive protein (CRP), and creatinine adds another limitation to the study.
The findings will be presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Copenhagen, Denmark (15-18 April).
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