Amoxicillin for acute lower respiratory tract infection in primary care: subgroup analysis by bacterial and viral aetiology
Amoxicillin for acute lower respiratory tract infection in primary care: subgroup analysis by bacterial and viral aetiology
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.
Aetiology, Amoxicillin, Illness deterioration, Lower respiratory tract infection, Symptom duration, Symptom severity
Bruyndonckx, R.
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Stuart, B.
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Little, P.
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Hens, N.
ae31e0dd-2c9b-47b7-91b8-814f44ea6de8
Ieven, M.
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Butler, C.C.
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Verheij, T.
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Goossens, H.
533640f7-b568-4d95-a7c1-28158d154ba8
Coenen, S.
9afe2a52-9f4f-45bb-b8e5-c6ee3eeb3498
Bruyndonckx, R.
f4de37c8-5255-4d22-936b-62a7c900c81a
Stuart, B.
626862fc-892b-4f6d-9cbb-7a8d7172b209
Little, P.
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Hens, N.
ae31e0dd-2c9b-47b7-91b8-814f44ea6de8
Ieven, M.
c138048d-d838-4c8e-848d-a43e309f4cf0
Butler, C.C.
736f78ad-3e18-4c63-900f-c2249577b645
Verheij, T.
cc355b92-ba85-4102-98a0-cee55f0504f6
Goossens, H.
533640f7-b568-4d95-a7c1-28158d154ba8
Coenen, S.
9afe2a52-9f4f-45bb-b8e5-c6ee3eeb3498
Bruyndonckx, R., Stuart, B., Little, P., Hens, N., Ieven, M., Butler, C.C., Verheij, T., Goossens, H. and Coenen, S.
,
The GRACE project group
(2017)
Amoxicillin for acute lower respiratory tract infection in primary care: subgroup analysis by bacterial and viral aetiology.
Clinical Microbiology and Infection.
(doi:10.1016/j.cmi.2017.10.032).
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.
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Accepted/In Press date: 31 October 2017
e-pub ahead of print date: 3 November 2017
Keywords:
Aetiology, Amoxicillin, Illness deterioration, Lower respiratory tract infection, Symptom duration, Symptom severity
Identifiers
Local EPrints ID: 416996
URI: http://eprints.soton.ac.uk/id/eprint/416996
ISSN: 1198-743X
PURE UUID: 17df8cc7-7ceb-4672-9fa3-eda335fae3fc
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Date deposited: 16 Jan 2018 17:30
Last modified: 16 Apr 2024 04:01
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Contributors
Author:
R. Bruyndonckx
Author:
N. Hens
Author:
M. Ieven
Author:
C.C. Butler
Author:
T. Verheij
Author:
H. Goossens
Author:
S. Coenen
Corporate Author: The GRACE project group
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