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Disease course of lower respiratory tract infection with a bacterial cause

Disease course of lower respiratory tract infection with a bacterial cause
Disease course of lower respiratory tract infection with a bacterial cause
PURPOSE Bacterial pathogens are assumed to cause an illness course different from that of nonbacterial causes of acute cough, but evidence is lacking. We evaluated the disease course of lower respiratory tract infection (LRTI) with a bacterial cause in adults with acute cough.

METHODS We conducted a secondary analysis of a multicenter European trial in which 2,061 adults with acute cough (28 days’ duration or less) were recruited from primary care and randomized to amoxicillin or placebo. For this analysis only patients in the placebo group (n = 1,021) were included, reflecting the natural course of disease. Standardized microbiological and serological analyses were performed at baseline to define a bacterial cause. All patients recorded symptoms in a diary for 4 weeks. The disease course between those with and without a bacterial cause was compared by symptom severity in days 2 to 4, duration of symptoms rated moderately bad or worse, and a return consultation.

RESULTS Of 1,021 eligible patients, 187 were excluded for missing diary records, leaving 834 patients, of whom 162 had bacterial LRTI. Patients with bacterial LRTI had worse symptoms at day 2 to 4 after the first office visit (P = .014) and returned more often for a second consultation, 27% vs 17%, than those without bacterial LRTI (P = .004). Resolution of symptoms rated moderately bad or worse did not differ (P = .375).

CONCLUSIONS Patients with acute bacterial LRTI have a slightly worse course of disease when compared with those without an identified bacterial cause, but the relevance of this difference is not meaningful.
1544-1709
534-539
Teepe, Jolien
54285976-b741-4a48-8d78-4e92f17d6023
Broekhuizen, Berna D.L.
58780c58-a133-4b22-ab3d-b30261859a62
Loens, Katherine
4c3dc94c-70c4-47d4-bde5-9a41d2d904f3
Lammens, Christine
5c95854e-7ed4-4932-a4c1-55c3555d5bb5
Ieven, Margareta
c138048d-d838-4c8e-848d-a43e309f4cf0
Goossens, Herman
31f8e1ae-7da0-473c-bd49-f911c2187451
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Butler, Christopher C.
2782a915-eb8d-48bb-ae70-118114697f57
Coenen, Samuel
3d0dc4e0-e5ba-4d66-ba92-15900ccc551e
Godycki-Cwirko, Maciek
306b5836-4955-470d-bf1f-77c6ac282138
Verheij, Theo
772e019f-486f-4a64-9260-bac6446a85d2
GRACE Consortium
Teepe, Jolien
54285976-b741-4a48-8d78-4e92f17d6023
Broekhuizen, Berna D.L.
58780c58-a133-4b22-ab3d-b30261859a62
Loens, Katherine
4c3dc94c-70c4-47d4-bde5-9a41d2d904f3
Lammens, Christine
5c95854e-7ed4-4932-a4c1-55c3555d5bb5
Ieven, Margareta
c138048d-d838-4c8e-848d-a43e309f4cf0
Goossens, Herman
31f8e1ae-7da0-473c-bd49-f911c2187451
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Butler, Christopher C.
2782a915-eb8d-48bb-ae70-118114697f57
Coenen, Samuel
3d0dc4e0-e5ba-4d66-ba92-15900ccc551e
Godycki-Cwirko, Maciek
306b5836-4955-470d-bf1f-77c6ac282138
Verheij, Theo
772e019f-486f-4a64-9260-bac6446a85d2

Teepe, Jolien, Broekhuizen, Berna D.L., Loens, Katherine, Lammens, Christine, Ieven, Margareta, Goossens, Herman, Little, Paul, Butler, Christopher C., Coenen, Samuel, Godycki-Cwirko, Maciek and Verheij, Theo , GRACE Consortium (2016) Disease course of lower respiratory tract infection with a bacterial cause. Annals of Family Medicine, 14 (6), 534-539. (doi:10.1370/afm.1974).

Record type: Article

Abstract

PURPOSE Bacterial pathogens are assumed to cause an illness course different from that of nonbacterial causes of acute cough, but evidence is lacking. We evaluated the disease course of lower respiratory tract infection (LRTI) with a bacterial cause in adults with acute cough.

METHODS We conducted a secondary analysis of a multicenter European trial in which 2,061 adults with acute cough (28 days’ duration or less) were recruited from primary care and randomized to amoxicillin or placebo. For this analysis only patients in the placebo group (n = 1,021) were included, reflecting the natural course of disease. Standardized microbiological and serological analyses were performed at baseline to define a bacterial cause. All patients recorded symptoms in a diary for 4 weeks. The disease course between those with and without a bacterial cause was compared by symptom severity in days 2 to 4, duration of symptoms rated moderately bad or worse, and a return consultation.

RESULTS Of 1,021 eligible patients, 187 were excluded for missing diary records, leaving 834 patients, of whom 162 had bacterial LRTI. Patients with bacterial LRTI had worse symptoms at day 2 to 4 after the first office visit (P = .014) and returned more often for a second consultation, 27% vs 17%, than those without bacterial LRTI (P = .004). Resolution of symptoms rated moderately bad or worse did not differ (P = .375).

CONCLUSIONS Patients with acute bacterial LRTI have a slightly worse course of disease when compared with those without an identified bacterial cause, but the relevance of this difference is not meaningful.

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Accepted/In Press date: 9 May 2016
e-pub ahead of print date: 14 November 2016
Published date: November 2016
Organisations: Primary Care & Population Sciences

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Local EPrints ID: 407580
URI: https://eprints.soton.ac.uk/id/eprint/407580
ISSN: 1544-1709
PURE UUID: c36a3cf3-2d1c-4e3a-bfb2-7402d53262c8

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Date deposited: 16 Apr 2017 16:57
Last modified: 04 Nov 2019 18:54

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Contributors

Author: Jolien Teepe
Author: Berna D.L. Broekhuizen
Author: Katherine Loens
Author: Christine Lammens
Author: Margareta Ieven
Author: Herman Goossens
Author: Paul Little
Author: Christopher C. Butler
Author: Samuel Coenen
Author: Maciek Godycki-Cwirko
Author: Theo Verheij

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