A study carried out by researchers at the University of Southampton has concluded that amoxicillin, Britain’s most widely used antibiotic, is “useless” for the majority of people who are currently prescribed it for coughs and common chest infections.
Paul Little, Professor of Primary Care Research at the University of Southampton said that patients should instead take paracetamol and wait to get better. He argued that the study should be the “final nail” that killed of widespread prescribing of antibiotics for minor ailments. More than 13 million prescriptions for amoxicillin were written by GPs last year, and the NHS spends £16 million a year on it.
Patients should simply take some paracetamol and wait to get better, experts say. Family doctors should stop prescribing the drug in most cases, researchers advise, to prevent side-effects and stem the rise of superbugs.
More than 13 million prescriptions for amoxicillin were written by GPs last year, a third of all antibiotic prescriptions in England.
But Paul Little, Professor of Primary Care Research at the University of Southampton, who led the latest research, said: “It’s useless for most of the people who are getting it at the moment.”
He said the study should be the “final nail” that killed off widespread prescribing of antibiotics for minor ailments. As well as concerns over antibiotic resistance, emerging evidence has suggested that many common problems were not caused by bacteria and could not, therefore, be treated by antibiotics.
To resolve the issue, scientists carried out a trial of more than 2,000 patients around Europe with common chest complaints, for which amoxicillin is most commonly prescribed. Half the patients were given the antibiotic while the rest were given a placebo.
After a week, symptoms had lasted just as long and were just as bad in both groups, they report in The Lancet Infectious Diseases.
While 16 per cent of patients taking amoxicillin said their symptoms got worse, compared to 19 per cent of the placebo group, this was outweighed by side-effects such as nausea, rashes and diarrhoea which were seen in 29 per cent of people taking the drug, compared to 24 per cent of the placebo group.
“Patients given amoxicillin don’t recover much quicker or have significantly fewer symptoms,” Professor Little said. “People just need to take paracetamol or ibuprofen, look after themselves and wait for the thing to settle.
Like all antibiotics, amoxicillin is effective at killing bacteria. But Professor Little said this was no help against most mild respiratory problems. “The evidence to date suggests that a large proportion of these infections are caused by viruses and therefore antibiotics just aren’t going to work,” he said.
Even when were infections are caused by bacteria, inflammation can linger even after the bugs are killed off, meaning antibiotics are no help in shortening symptoms.
GPs needed to get tough and break the cycle which made patients ask for antibiotics. The NHS spends £16 million a year on amoxicillin and tens of millions more on other antibiotics. “If you prescribe these antibiotics, patients get better and they ascribe that to the antibiotic and so you get into this cycle of medicalising illness,” he said.
“These infections can last for three weeks — it’s a very nuisancy illness. You can’t blame people for wanting to be assessed but I think we have a responsibility.”
He said the research was “pretty definitive evidence, really. The issue now is can we identify the subgroups who can benefit.”
Amoxicillin can cure pneumonia, which can be fatal if not treated and Professor Little said more effort was needed to identify the minority of patients who really needed the drug.
“I think GPs should have a high threshold for prescribing antibiotics where they don’t think the patient has pneumonia. We have to be a bit cautious”, he said. “Using amoxicillin to treat respiratory infections in patients not suspected of having pneumonia is not likely to help and could be harmful.”
Campaigners have repeatedly warned that overuse of antibiotics by GPs is fuelling the rise of life-threatening superbugs, as bacteria evolve resistance. Last month Professor Dame Sally Davies, the Chief Medical Officer, said that antibiotic resistance was one of the greatest threats to modern medicine.
Professor Little added: “Resistance is a serious problem. There aren’t really any new antibiotics coming in the pipeline and we know that if we overuse antibiotics they will at some stage become useless. We all want our children to have antibiotics that work for them when they have a serious illness, so we do have to be careful about conserving the antibiotic stock.”
Dr Michael Moore, spokesman for the Royal College of GPs, who was involved in the study, said: “It is important that GPs are clear when they should and should not prescribe antibiotics to patients to reduce the emergence of bacterial resistance in the community. This study backs the approach taken in the NICE guidelines that patients who present with acute lower respiratory tract infection where pneumonia is not suspected can be reassured by their GP that they will recover without antibiotics and that the illness is likely to last about three weeks in total whether or not they have a prescription.”
The Department of Health said: “The more you use an antibiotic, the more bacteria become resistant to it. Therefore the Government urges patients and prescribers to think about the drugs they are requesting and dispensing and only use them when necessary.”