One great example of “When less is more…”

By Leonardo Pagani (ESGAP EC member)


About 60% of antibiotics prescribed in primary care are for RTIs, such as common colds, sore throat, cough, acute bronchitis, otitis media and sinusitis. Antibiotic treatment of RTIs often offers negligible benefit, as these illnesses are often self-limiting and usually improve without specific treatment; on the other hand, such treatments may be associated with side-effects to the patient, and are unquestionably associated with increased antimicrobial resistance.

By means of electronic health records in the UK from 2005 to 2014, Gulliford and colleagues on BMJ (see here) showed that general practices that adopt a true policy to reduce antibiotic prescription for RTIs should not expect an increase in invasive or complicated infections, such as mastoiditis, empyema, bacterial meningitis, or cerebral abscess, following RTIs. Only a slight increase in the incidence of treatable pneumonia or peritonsillar abscess might be foreseen.

The safety outcomes of this study highlight some critical points:

  • A large reduction in antibiotic prescribing would be expected to reduce the risk of AMR, the side effects of antibiotics, and the costs associated to likely self-limiting illnesses, with only a small increase in numbers of mild cases observed over a 10 year period
  • A wider strategy to support effective antimicrobial stewardship should rely also on important aspects of communication (education) to patients, families, and GPs.

We will always welcome such kind of experiences on our pages.

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