Could Withholding Antibiotics from Patients with Upper Respiratory Infections Cause Harm?

Everyone agrees that too many antibiotics are prescribed for upper respiratory infections (URIs). Still, curtailing antibiotic prescriptions theoretically might result in additional rare but serious pyogenic complications of URI (e.g., peritonsillar abscess, pneumonia, meningitis). Few studies to date have been powered adequately to address this concern. In this study, British researchers tallied antibiotic prescription data and diagnostic codes in a giant database generated by more than 600 primary care practices, with more than 45 million patient-years of observation from 2005 through 2014.

During the 10-year study period, overall antibiotic prescribing rates for URIs declined minimally, from 54% to 51%. Among practices that prescribed ant…