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Treatment of acute cough/lower respiratory tract infection by antiobiotic class and associated outcomes: a 13 European country observational study in primary care

Treatment of acute cough/lower respiratory tract infection by antiobiotic class and associated outcomes: a 13 European country observational study in primary care
Treatment of acute cough/lower respiratory tract infection by antiobiotic class and associated outcomes: a 13 European country observational study in primary care
Objectives: Acute cough/lower respiratory tract infection (LRTI) is one of the commonest reasons for consulting and antibiotic prescribing. There are theoretical reasons why treatment with particular antibiotic classes may aid recovery more than others, but empirical, pragmatic evidence is lacking. We investigated whether treatment with a particular antibiotic class (amoxicillin) was more strongly associated with symptom score resolution and time to patients reporting recovery than each of eight other antibiotic classes or no antibiotic treatment for acute cough/LRTI.

Methods: Clinicians recorded history, examination findings, symptom severity and antibiotic treatment for 3402 patients in a 13 country prospective observational study of adults presenting in 14 primary care research networks with acute cough/LRTI. 2714 patients completed a symptom score daily for up to 28 days and recorded the day on which they felt recovered. A three-level autoregressive moving average model (1,1) model investigated logged daily symptom scores to analyse symptom resolution. A two-level survival model analysed time to reported recovery. Clinical presentation was controlled for using clinician-recorded symptoms, sputum colour, temperature, age, co-morbidities, smoking status and duration of illness prior to consultation.

Results: Compared with amoxicillin, no antibiotic class (and no antibiotic treatment) was associated with clinically relevant improved symptom resolution (all coefficients in the range ?0.02 to 0.01 and all P values greater than 0.12). No antibiotic class (and no antibiotic treatment) was associated with faster time to recovery than amoxicillin.

Conclusions: Treatment by antibiotic class was not associated with symptom resolution or time to recovery in adults presenting to primary care with acute cough/LRTI.
antibiotic resistance, patient outcome, clinical epidemiology, antibiotic choice
0305-7453
2472-2478
Butler, Christopher C.
2782a915-eb8d-48bb-ae70-118114697f57
Hood, Kerenza
62906d76-4931-4b12-9a64-0c867c7b84c1
Kelly, Mark J.
738a2267-4c22-4016-96ab-9a2c935e7e35
Goossens, Herman
31f8e1ae-7da0-473c-bd49-f911c2187451
Verheij, Theo
772e019f-486f-4a64-9260-bac6446a85d2
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Melbye, Hasse
be60ca95-b236-48e5-8eb9-c9a153d54a8f
Torres, Antoni
c505b4da-00c7-46ed-9296-985d9c120350
Molstad, H
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Godycki-Cwirko, Maciek
306b5836-4955-470d-bf1f-77c6ac282138
Almirall, Jordi
3ce2b3e5-73eb-4faf-a530-1195f2fe7c3d
Blasi, Francesco
5758c460-00f5-4c63-bada-e2b50b47a625
Schaberg, Tom
cb82c244-0926-4376-bda8-a0b921e87532
Edwards, Peter
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Rautakorpi, Ulla-Maija
49eb7a17-2c89-4b7e-bbde-02dae82fe63f
Hupkova, Helena
8db25e4a-50c6-47dd-8a7a-56d641817341
Wood, Joseph
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Nuttall, Jacqui
b4c18569-1ab8-4fb6-b72d-1a61ad271a1a
Coenen, Samuel
3d0dc4e0-e5ba-4d66-ba92-15900ccc551e
Butler, Christopher C.
2782a915-eb8d-48bb-ae70-118114697f57
Hood, Kerenza
62906d76-4931-4b12-9a64-0c867c7b84c1
Kelly, Mark J.
738a2267-4c22-4016-96ab-9a2c935e7e35
Goossens, Herman
31f8e1ae-7da0-473c-bd49-f911c2187451
Verheij, Theo
772e019f-486f-4a64-9260-bac6446a85d2
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Melbye, Hasse
be60ca95-b236-48e5-8eb9-c9a153d54a8f
Torres, Antoni
c505b4da-00c7-46ed-9296-985d9c120350
Molstad, H
8b075ccd-be39-46d5-975d-0141ff2e746c
Godycki-Cwirko, Maciek
306b5836-4955-470d-bf1f-77c6ac282138
Almirall, Jordi
3ce2b3e5-73eb-4faf-a530-1195f2fe7c3d
Blasi, Francesco
5758c460-00f5-4c63-bada-e2b50b47a625
Schaberg, Tom
cb82c244-0926-4376-bda8-a0b921e87532
Edwards, Peter
5ee73a94-75a0-426f-ab1b-ce918b06a1ea
Rautakorpi, Ulla-Maija
49eb7a17-2c89-4b7e-bbde-02dae82fe63f
Hupkova, Helena
8db25e4a-50c6-47dd-8a7a-56d641817341
Wood, Joseph
4c46b5db-d461-424c-a80d-a4b1cc548574
Nuttall, Jacqui
b4c18569-1ab8-4fb6-b72d-1a61ad271a1a
Coenen, Samuel
3d0dc4e0-e5ba-4d66-ba92-15900ccc551e

Butler, Christopher C., Hood, Kerenza, Kelly, Mark J., Goossens, Herman, Verheij, Theo, Little, Paul, Melbye, Hasse, Torres, Antoni, Molstad, H, Godycki-Cwirko, Maciek, Almirall, Jordi, Blasi, Francesco, Schaberg, Tom, Edwards, Peter, Rautakorpi, Ulla-Maija, Hupkova, Helena, Wood, Joseph, Nuttall, Jacqui and Coenen, Samuel (2010) Treatment of acute cough/lower respiratory tract infection by antiobiotic class and associated outcomes: a 13 European country observational study in primary care. Journal of Antimicrobial Chemotherapy, 65 (11), 2472-2478. (doi:10.1093/jac/dkq336). (PMID:20852271)

Record type: Article

Abstract

Objectives: Acute cough/lower respiratory tract infection (LRTI) is one of the commonest reasons for consulting and antibiotic prescribing. There are theoretical reasons why treatment with particular antibiotic classes may aid recovery more than others, but empirical, pragmatic evidence is lacking. We investigated whether treatment with a particular antibiotic class (amoxicillin) was more strongly associated with symptom score resolution and time to patients reporting recovery than each of eight other antibiotic classes or no antibiotic treatment for acute cough/LRTI.

Methods: Clinicians recorded history, examination findings, symptom severity and antibiotic treatment for 3402 patients in a 13 country prospective observational study of adults presenting in 14 primary care research networks with acute cough/LRTI. 2714 patients completed a symptom score daily for up to 28 days and recorded the day on which they felt recovered. A three-level autoregressive moving average model (1,1) model investigated logged daily symptom scores to analyse symptom resolution. A two-level survival model analysed time to reported recovery. Clinical presentation was controlled for using clinician-recorded symptoms, sputum colour, temperature, age, co-morbidities, smoking status and duration of illness prior to consultation.

Results: Compared with amoxicillin, no antibiotic class (and no antibiotic treatment) was associated with clinically relevant improved symptom resolution (all coefficients in the range ?0.02 to 0.01 and all P values greater than 0.12). No antibiotic class (and no antibiotic treatment) was associated with faster time to recovery than amoxicillin.

Conclusions: Treatment by antibiotic class was not associated with symptom resolution or time to recovery in adults presenting to primary care with acute cough/LRTI.

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More information

Published date: 18 September 2010
Keywords: antibiotic resistance, patient outcome, clinical epidemiology, antibiotic choice

Identifiers

Local EPrints ID: 168095
URI: https://eprints.soton.ac.uk/id/eprint/168095
ISSN: 0305-7453
PURE UUID: bbdad222-0ef0-4877-9e25-296dd19b2706

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Date deposited: 24 Nov 2010 10:11
Last modified: 18 Jul 2017 12:23

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Contributors

Author: Christopher C. Butler
Author: Kerenza Hood
Author: Mark J. Kelly
Author: Herman Goossens
Author: Theo Verheij
Author: Paul Little
Author: Hasse Melbye
Author: Antoni Torres
Author: H Molstad
Author: Maciek Godycki-Cwirko
Author: Jordi Almirall
Author: Francesco Blasi
Author: Tom Schaberg
Author: Peter Edwards
Author: Ulla-Maija Rautakorpi
Author: Helena Hupkova
Author: Joseph Wood
Author: Jacqui Nuttall
Author: Samuel Coenen

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