Whether antibiotics help in cases of uncomplicated acute lower respiratory tract infection has been debated. In a recent study to answer that question, patients with a probable diagnosis of lower respiratory tract infection-but not pneumonia-were recruited at primary care practices across 12 European countries. A total of 1,038 patients were randomized to receive amoxicillin (1 g three times daily) and 1,023 to receive placebo. Patients completed daily diaries rating their symptoms, such as cough, phlegm, shortness of breath, and wheezing, on a scale from "no problem" to "as bad as it could be."

In the amoxicillin group, symptoms rated by patients as "moderately bad" or worse lasted a median of six days, compared with seven days in the placebo group-a nonsignificant difference. Similarly, the severity of symptoms was comparable between groups. The only significant difference was that fewer patients in the amoxicillin group experienced new or worsened symptoms. No differences in symptom duration or severity were seen between patients either younger than 60 years or 60 years old or older. Among 867 participants in the amoxicillin group with data concerning adverse effects, 29% reported experiencing nausea, rash, and diarrhea, compared with 24% of 860 patients in the placebo group.

The authors conclude that, compared with placebo, amoxicillin didn't significantly affect the severity or duration of symptoms in patients with lower respiratory tract infections. They state that the mild benefits offered by antibiotics must be weighed against the resulting adverse effects, as well as the prospect of long-term antibiotic resistance.

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