Purpose: Patients frequently request antibiotics for their acute upper respiratory illnesses (URI) despite the lack of clinical effectiveness of these medications. Seeking an explanation for this behavior we studied whether patients treated with antibiotics experience more rapid improvements in their health-related quality of life (QOL), a benefit perhaps missed by more routine clinical measures.

Methods: All adult patients seen in a family practice clinic for acute respiratory symptoms were eligible for this study. Subjects with a diagnosis of asthma exacerbation or COPD were excluded. Decisions to prescribe antibiotics were left to the physicians. Subjects completed the Quality of Well-Being questionnaire during the initial clinic visit and on Days 3, 7, 14, and 28 by phone. Two-tailed t-tests were used to compare QOL by treatment assignment and adverse events using an alpha of 0.01 to correct for multiple comparisons.

Results: 65 patients with a mean age of 37 years (range 18-70) were enrolled. 75% of the subjects were women. URI was the most common diagnosis made by the physicians (48%) followed by sinusitis (23%) and pharyngitis (16%). 31 subjects received antibiotics with azithomycin being most commonly prescribed (45%) followed by amoxicillin (32%). A total of 13 subjects reported adverse effects from antibiotics including 10 who reported GI disturbances.

The mean QOL for all subjects improved during the study period, starting at 0.68 at the base line visit and increasing to 0.80 on Day 28 (p<0.001). Subjects receiving antibiotics reported similar QOL at follow-up as subjects not receiving antibiotics except on Day 3 when patients receiving antibiotics had a significantly lower QOL (0.70 vs. 0.74, p<0.01). There were no differences in QOL at any follow-up time when the subjects reporting antibiotic adverse effects were removed from the analysis. Additionally, subjects experiencing adverse effects had lower QOL at each follow-up time compared to the subjects who did not report adverse effects, but this difference in QOL was significant only on Day 3 (0.68 vs. 0.74, p<0.001).

Conclusion: Patients seeking medical care for respiratory illness demonstrate a significant increase in their QOL over a one month period of follow-up. We found that the use of antibiotics did not positively influence the QOL of patients but common adverse effects associated with antibiotics have a measurable negative impact on QOL.