Anti antibiotic treatment for nose colds

The following is from the British Medical Journal 2006. We hope it is useful.

Acute Purulent Rhinitis Often Resolves Without Antibiotics
July 25, 2006 --

Antibiotics may be helpful for acute purulent rhinitis but may also be harmful, according to the results of a meta-analysis reported in the July 21 Online First issue of the BMJ. Most will get better without antibiotics, supporting the "no antibiotics first" guideline.

"Most guidelines recommend that antibiotics should not be used for this condition, citing one study that found no evidence that antibiotics reduce the duration of acute purulent rhinitis," write B. Arroll, MD, and T. Kenealy, MD, from the University of Auckland in New Zealand, and colleagues. "However, a recent larger study reported that treatment with amoxicillin reduced the duration of purulent rhinitis, although it found no significant difference between the groups in terms of general improvement in symptoms. Concern exists about overuse of antibiotics leading to bacterial resistance."

Using MEDLINE, Embase, Cochrane Register of Controlled Trials, and reference lists of retrieved articles, the authors systematically searched for studies on the effectiveness and harms of antibiotics for acute purulent rhinitis. They then did a review and meta-analysis of data from double-blind, randomized, placebo-controlled trials comparing antibiotics with placebo for acute purulent rhinitis of duration less than 10 days.

Of 7 studies retrieved, 4 contributed data on the benefits of antibiotics, and 4 contributed data on harms of antibiotics. At 5 to 8 days, the pooled relative risk of benefit for persistent purulent rhinitis with antibiotics was 1.18 (95% confidence interval [CI], 1.05 - 1.33). When the pooled relative risk was applied to the range of control event rates, the numbers needed to treat ranged from 7 to 15.
The relative risk for adverse effects with antibiotics was 1.46 (95% CI, 1.10 - 1.94), and the numbers needed to harm for various adverse effects ranged from 12 to 78. Harms attributed to antibiotics were primarily vomiting, diarrhea, and abdominal pain, but there were also some reports of rashes and hyperactivity. There were no serious harms reported in the placebo groups.

"Antibiotics are probably effective for acute purulent rhinitis," the authors write. "They can cause harm, usually in the form of gastrointestinal effects. Most patients will get better without antibiotics, supporting the current 'no antibiotic as first line' advice."

Study limitations include the possibility of missing some relevant articles because various terms are used for acute purulent rhinitis, publication bias, and use of different antibiotics in the various studies.

"Our summation would be to suggest initial management by non-antibiotic treatments or 'watchful waiting,' and that antibiotics should be used only when symptoms have persisted for long enough to concern parents or patients," the authors conclude. "In this case, antibiotic treatment may be considered, given that the harms were usually gastrointestinal adverse effects and that individual patients may be aware of their own ability to tolerate specific antibiotics. Our findings are consistent with the review on antibiotics for chronic purulent rhinitis, and we do not feel that more randomised controlled trials on this subject are warranted."

This review was funded by the Charitable Trust of the Auckland Faculty of the Royal New Zealand College of General Practitioners, and the authors' salaries were from University of Auckland staff funding. Dr. Arroll has disclosed being a member of the Future Forum, an educational foundation funded by AstraZeneca UK, and a committee member of the Pharmac seminar series (Pharmac is the New Zealand government funding agency for drugs).

BMJ. Published online July 21, 2006.