Efforts to curb excessive antibiotic use have been pursued in many Western countries over the past few decades in response to the growing problem of antibiotic resistance in common bacteria. Education campaigns have quite sensibly tried to convince both doctors and the general public that antibiotics are not always required, especially in the treatment of respiratory tract infections, given that etiologic studies show a large proportion are due to viral pathogens.
In this issue of CHEST (see page 1163), the analysis of a large general practice database in the United Kingdom by Winchester and colleagues1 suggests that limiting antibiotic use in the treatment of lower respiratory tract infections (LRTIs) in the general practice setting may be having significant adverse consequences on patient outcomes. This study was in part prompted by other research2 in the United Kingdom suggesting that the prescription of antibiotics in the setting of an LRTI reduces the risk of subsequent pneumonia. Although 86% of patients identified by Winchester and colleagues1 were prescribed an antibiotic when presenting to a general practitioner with an LRTI, the 14% who did not had a threefold increase in respiratory infection-related mortality.