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Title: | Amoxicillin for acute lower respiratory tract infection in primary care: subgroup analysis by bacterial and viral aetiology | Authors: | BRUYNDONCKX, Robin Stuart, B. Little, P. HENS, Niel Ieven, Margareta Butler, C. C. Verheij, T. Goossens, H. Coenen, S. |
Issue Date: | 2018 | Publisher: | ELSEVIER SCI LTD | Source: | CLINICAL MICROBIOLOGY AND INFECTION, 24(8), p. 871-876 | Abstract: | Objective: We aimed to assess the effects of amoxicillin treatment in adult patients presenting to primary care with a lower respiratory tract infection (LRTI) who were infected with a potential bacterial, viral, or mixed bacterial/viral infection. Methods: This multicentre randomized controlled trial focused on adults with LRTI not suspected for pneumonia. Patients were randomized to receive either antibiotic (amoxicillin 1 g) or placebo three times daily for 7 consecutive days using computer-generated random numbers (follow-up 28 days). In this secondary analysis of the trial, symptom duration (primary outcome), symptom severity (scored 0-6), and illness deterioration (reconsultation with new or worsening symptoms, or hospital admission) were analysed in pre-specified subgroups using regression models. Subgroups of interest were patients with a (strictly) bacterial, (strictly) viral, or combined infection, and patients with elevated values of procalcitonin, C-reactive protein, or blood urea nitrogen. Results: 2058 patients (amoxicillin n = 1036; placebo n = 1022) were randomized. Treatment did not affect symptom duration (n = 1793). Patients from whom a bacterial pathogen only was isolated (n = 207) benefited from amoxicillin in that symptom severity (n = 804) was reduced by 0.26 points (95% CI -0.48 to -0.03). The odds of illness deterioration (n = 2024) was 0.24 (95% CI 0.11 to 0.53) times lower from treatment with amoxicillin when both a bacterial and a viral pathogen were isolated (combined infection; n = 198). Conclusions: Amoxicillin may reduce the risk of illness deterioration in patients with a combined bacterial and viral infection. We found no clinically meaningful benefit from amoxicillin treatment in other subgroups. (C) 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved. | Notes: | Hasselt Univ, Interuniv Inst Biostat & Stat Bioinformat IBIOSTA, Hasselt, Belgium. Univ Antwerp, Vaccine & Infect Dis Inst VAXINFECTIO, Lab Med Microbiol, Antwerp, Belgium. Univ Southampton, Aldermoor Hlth Ctr, Southampton, Hants, England. Univ Antwerp, Ctr Hlth Econ Res & Modelling Infect Dis CHERMID, Vaccine & Infect Dis Inst, Antwerp, Belgium. Cardiff Univ, Inst Primary Care & Publ Hlth, Cardiff, S Glam, Wales. Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands. Univ Antwerp, Dept Primary & Interdisciplinary Care ELIZA, Antwerp, Belgium. Univ Antwerp, Dept Epidemiol & Social Med ESOC, Antwerp, Belgium. | Keywords: | Aetiology;Amoxicillin;Illness deterioration;Lower respiratory tract infection;Symptom duration;Symptom severity | Document URI: | http://hdl.handle.net/1942/27354 | ISSN: | 1198-743X | e-ISSN: | 1469-0691 | DOI: | 10.1016/j.cmi.2017.10.032 | ISI #: | 000439403900015 | Rights: | 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved. | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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Amoxicillin for acute lower respiratory tract infection in primary care_ subgroup analysis by bacterial and viral aetiology.pdf Restricted Access | Published version | 598.62 kB | Adobe PDF | View/Open Request a copy |
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