A sweeping analysis of more than a thousand patients finds that antibiotics offer no relief for viral colds or purulent nasal discharge, while increasing side effects.
Study: Antibiotics for the common cold and acute purulent rhinitis. Image Credit: Dragana Gorgic / Shutterstock.com
In a recent study published in Cochrane Database of Systematic Reviews, researchers conclude that antibiotics should not be used to treat the common cold and acute purulent rhinitis.
How is the common cold treated?
The common cold is an acute upper respiratory tract infection experienced by most of the global population annually. Although common colds are medically characterized as self-limiting viral infections that render antibiotics ineffective, many patients who present to their general practitioners receive antibiotics for these conditions.
The propensity of prescribing antibiotics further increases when patients have colored nasal discharge, a condition medically referred to as acute purulent rhinitis. Established guidelines do not typically recommend antibiotics for these conditions; however, these guidelines are supported by a limited number of small studies with varying methodological quality.
Due to the potential risk of adverse health outcomes and the global impact of antibiotic resistance because of antibiotic overuse, it is crucial to determine the effectiveness of antibiotics for treating conditions like the common cold.
Comparing antibiotics against placebo in early symptoms
Researchers from the University of Auckland searched various electronic databases and identified six studies of the common cold comprising 1,047 participants, as well as five studies of acute purulent rhinitis with 791 participants. These studies were analyzed to determine the effectiveness and side effects of antibiotic treatment for the common cold and acute purulent rhinitis.
Specifically, the meta-analysis included randomized controlled trials comparing any antibiotic therapy against placebo in patients experiencing acute upper respiratory tract infection symptoms for less than seven days, or acute purulent rhinitis for less than ten days.
The primary objective of the current meta-analysis was to assess the efficacy of antibiotics as compared to placebo for reducing general and specific nasopharyngeal symptoms of common colds, acute purulent rhinitis, and acute clear rhinitis. The researchers also identified any significant adverse outcomes associated with antibiotic therapy for these conditions.
Antibiotics show no benefit for cold symptoms
The meta-analysis of six studies with a total of 1,147 participants revealed that antibiotics are not effective in terms of curing or improving symptoms of the common cold in children and adults. Antibiotics significantly increased the risk of adverse outcomes in adults as compared to placebo; however, no significant side effects were observed in children who received antibiotics for the common cold.
The meta-analysis of four studies of acute purulent rhinitis with 723 participants revealed similar outcomes as observed for the common cold.
Sid effects outweigh any theoretical symptom relief
The current systematic review and meta-analysis suggest that antibiotics are not effective in treating the common cold or acute purulent rhinitis. Rather, these medications significantly increase the risk of adverse health effects, especially among adults with the common cold and both adults and children with acute purulent rhinitis.
Antibiotics do not work for either the common cold or for acute purulent rhinitis and many people are affected by antibiotic side effects
Notably, many of the analyzed trials have methodological limitations that may have biased the findings, including issues with randomization methods, selection bias, the presence of bacterial comorbidities, and incomplete outcome data. The inclusion of participants with bacterial diseases such as streptococcal tonsillitis or bacterial sinusitis further contributed to this bias, as these comorbidities can overestimate the effectiveness of treatment.
Despite these risks of bias, the review findings emphasize that antibiotics should not be prescribed for treating the common cold, as they will not improve patient symptoms while simultaneously increasing the risk of adverse effects.
The lack of therapeutic benefits and risk of adverse effects have similarly been observed for acute purulent rhinitis. However, existing evidence suggests that antibiotic treatment may be effective in patients with acute purulent rhinitis if symptoms persist for more than ten days.
There remains an urgent need for future studies to ascertain the role of pathogenic nasopharyngeal bacteria and their presence in upper respiratory tract infections while meticulously reporting adverse effects and symptoms.
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