Benefits and risks of antibiotics in uncomplicated influenza, acute bronchitis, seromucous otitis and acute rhinopharyngitis. Elaboration of the physician's guide. Contribution to the "Top five list" in general practice

Context. In the fight against medical overuse, a French Top Five List has recently listed 5 medicals services frequently prescribed in family practice, despite unfavourable benefit-risk ratio. One of those was antibiotherapy. Objective. Synthetizing data of scientific literature about efficacy and safety of antibiotic use in uncomplicated influenza, acute bronchitis, seromucous otitis and acute rhinopharyngitis, into guides for the practitioners involved in the study of the "Top five list". Methods. Systematic reviews, meta-analysis of randomised controlled trial (RCT), RCT versus placebo, and observational studies were included. The databases consulted were Medline, Embase and the Cochrane Library. After quality assessment using reading grids, the most relevant studies were selected for the realization of guides. Results. Among 5 296 articles, 3 meta-analysis and 1 prospective cohort study were selected. There is no significant difference between antibiotics and placebo for treatment of uncomplicated influenza and acute rhinopharyngitis. For acute bronchitis, antibiotics reduce duration of days of cough (RR= -0.55 ; 95CI = -1.00 - -0.10). For seromucous otitis, antibiotics improve complete resolution on tympanometry at two to three months (NNT = 5), but studies on hearing levels shown incomplete and conflicting results. Antibiotics expose to side effects (NNH = 24). Conclusion. Antibiotics' prescription seems to not have clinical interest for the treatment of uncomplicated influenza, acute bronchitis of healthy subject, seromucous otitis and acute rhinopharyngitis.