Reducing Antibiotic Prescriptions for RTIs Didn’t Increase Serious Bacterial Complications

Reduced antibiotic prescribing may lead to increase in pneumonia, peritonsillar abscess cases.

Reducing antibiotic prescriptions for respiratory tract infections did not increase risk for the most serious bacterial complications, such as bacterial meningitis, but slightly increased the incidence of pneumonia and peritonsillar abscess, according to research published in BMJ.1

The study, led by researchers from King’s College London, analyzed patient records from 610 general practices in the United Kingdom, with more than 4 million patients, between 2004 and 2014. General practices with lower rates of antibiotic prescribing for respiratory tract infections did not have higher rates of serious bacterial complications, including: meningitis, mastoiditis, empyema, brain abscess, or Lemierre’s syndrome.

The researchers noted that practices that prescribed fewer antibiotics had slightly higher rates of pneumonia and peritonsillar abscess. The researchers estimated that if an average-sized general practice with 7000 patients reduced its antibiotic prescriptions to people with respiratory tract infections by 10%, there could be 1 extra case of pneumonia each year. They also estimated that reduced prescriptions could be linked to 1 extra case of peritonsillar abscess every 10 years.

The researchers wrote that reducing antibiotic use is likely to reduce the number of people experiencing adverse events. About 10% of people who take antibiotics experience common adverse events such as rashes, diarrhea and vomiting, while rare adverse events include anaphylaxis.

Professor Martin Gulliford, lead author from the Division of Health and Social Care Research at King’s College London, said in a prepared statement: “Overuse of antibiotics now may result in increasing infections by resistant bacteria in the future. Current treatment recommendations are to avoid antibiotics for self-limiting respiratory infections. Our results suggest that, if antibiotics are not taken, this should carry no increased risk of more serious complications. General practices prescribing fewer antibiotics may have slightly higher rates of pneumonia and peritonsillar abscess but even a substantial reduction in antibiotic prescribing may be associated with only a small increase in the numbers of cases observed. Both these complications can be readily treated once identified.”2

The researchers caution that the results represent averages across general practice populations; this study did not evaluate the outcome of prescribing decisions for individual patients.


  1. Gulliford MC, Moore MV, Little P, et al. Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health recordsBMJ. 2016 July 4. doi:10.1136/bmj.i3410 [Epub ahead of print]
  2. Study on safety of prescribing fewer antibiotics [press release]. London, England; Kings College London; July 5, 2016.