Antibiotic Prescription and Course of Therapy in Homeopathic, Anthroposophic, and Conventional Primary Care in the Treatment of Acute Upper Respiratory Tract Infections: A Non-Interventional Study

Background: Antibiotics are indispensable in modern medicine. However, in 2019, the World Health Organization included antimicrobial resistance (AMR) in the ten greatest global threats to human public health. Research on the potential of existing non-antibiotic medicines, in particular homeopathic-anthroposophic preparations, can support strategies against AMR. For treating uncomplicated acute upper respiratory tract infections and acute otitis media (URTI/AO), antibiotics are often unnecessary but nevertheless frequently used. We set out to investigate whether URTI/AO patients treated in homeopathic or anthroposophic practices, which aim to rigorously abstain from prescribing antibiotics whenever possible, show recovery patterns at least as good as conventional practices. Methods: This is a non-interventional, prospective, controlled study conducted in German family medicine, pediatric and ENT primary care practices, treating patients with statutory health insurance. Practices declare themselves as either homeopathic/anthroposophic (referred to as “complementary”) or conventional. A total of 650 URTI/AO patients 6 months of age or older (or their legal guardians), consenting to the documentation of their clinical data, complete symptom and quality-of-life questionnaires during the current visit, 7 days later, and a daily symptom diary for maximally 28 days. The primary outcome is the proportion of patients reporting complete/substantial recovery after 7 days. Additionally, therapy costs are assessed. Statistical analyses comparing complementary and conventional practices will rely on causal inference modeling, which can adjust for systematic bias resulting from the non-random allocation of patients to the practices. Results: Data recording started on November 5, 2024. Currently (December 1, 2024), approximately 60 physicians in 50 practices have documented 137 patients. Recruitment is scheduled to last until May 2025. Conclusion: This study aims to yield scientifically sound comparisons on antibiotic prescription rate and course of therapy of URTI/AO patients for complementary and conventional primary care practices.