A sweeping analysis of more than a thousand patients finds that antibiotics provide 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 Reviewsthe 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 that is dealt with by most of the world’s population annually. Although common colds are medically characterized as self-limiting viral infections that render antibiotics ineffective, many patients who present to their GPs are given antibiotics for these conditions.
The tendency to prescribe antibiotics further increases when patients have colored nasal discharge, a condition medically referred to as acute purulent rhinitis. Standard guidelines do not usually recommend antibiotics for these conditions. However, these guidelines are supported by a limited number of small studies of varying methodological quality.
Because of the potential risk of adverse health outcomes and the global impact of antibiotic resistance due to overuse of antibiotics, it is important to determine the effectiveness of antibiotics in treating conditions such as the common cold.
Comparison of antibiotics versus placebo in early symptoms
Researchers from the University of Auckland searched various online databases and found six studies of the common cold involving 1,047 participants, as well as five studies of acute purulent rhinitis involving 791 participants. These studies were analyzed to determine the effectiveness and side effects of antibiotic therapy for the common cold and acute purulent rhinitis.
Specifically, the meta-analysis included randomized controlled trials that compared any antibiotic treatment versus placebo in patients who experienced symptoms of acute upper respiratory tract infection 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 effectiveness of antibiotics compared with placebo in reducing general and specific nasopharyngeal symptoms of the common cold, acute purulent rhinitis, and acute clear rhinitis. The researchers also identified any significant adverse outcomes associated with antibiotic treatment 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 treating or improving the symptoms of the common cold in children and adults. Antibiotics significantly increased the risk of adverse outcomes in adults compared with placebo. However, no significant side effects were seen in children who received antibiotics for the common cold.
A meta-analysis of four studies of acute purulent rhinitis with 723 participants revealed similar results to those seen for the common cold.
The side effects outweigh any theoretical symptom relief
The current systematic review and meta-analysis suggest that antibiotics are not effective in the treatment of the common cold or acute purulent rhinitis. Instead, these drugs significantly increase the risk of adverse health effects, especially among adults with the common cold and in both adults and children with acute purulent rhinitis.
Antibiotics do not work for either the common cold or acute sinusitis, and many people are affected by side effects of antibiotics
Notably, many of the trials analyzed have methodological limitations that may have biased the findings, including issues with randomization methods, selection bias, presence of bacterial comorbidities, and missing outcome data. The inclusion of participants with bacterial diseases such as streptococcal tonsillitis or bacterial sinusitis further contributed to this bias, as these comorbidities may overestimate the effectiveness of treatment.
Despite these risks of bias, the review’s findings emphasize that antibiotics should not be prescribed to treat the common cold, as they will not improve patients’ symptoms while increasing the risk of adverse effects.
The lack of therapeutic benefits and the risk of adverse effects have similarly been observed for acute purulent rhinitis. However, existing evidence suggests that antibiotic therapy 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.
