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Relationship between microbiology of throat swab and clinical course among primary care patients with acute cough: a prospective cohort study

Relationship between microbiology of throat swab and clinical course among primary care patients with acute cough: a prospective cohort study
Relationship between microbiology of throat swab and clinical course among primary care patients with acute cough: a prospective cohort study

Background: acute lower respiratory tract infections (ALRTIs) account for most antibiotics prescribed in primary care despite lack of efficacy, partly due to clinician uncertainty about aetiology and patient concerns about illness course. Nucleic acid amplification tests could assist antibiotic targeting.

Methods: in this prospective cohort study, 645 patients presenting to primary care with acute cough and suspected ALRTI, provided throat swabs at baseline. These were tested for respiratory pathogens by real-time Polymerase Chain Reaction and classified as having a respiratory virus, bacteria, both or neither. 354 participants scored the symptoms severity daily for one week in a diary (0=absent to 4=severe problem).

Results: organisms were identified in 346/645 (53.6%) participants. There were differences in the prevalence of seven symptoms between the organism groups at baseline. Those with a virus alone, and those with both virus and bacteria, had higher average severity scores of all symptoms combined during the week of follow-up than those in whom no organisms were detected (adjusted mean differences 0.204 (95% confidence interval 0.010 to 0.398) and 0.348 (0.098 to 0.598) respectively). There were no differences in duration of symptoms rated as moderate or severe between organism groups.

Conclusions: differences in presenting symptoms and symptoms severity can be identified between patients with viruses and bacteria identified on throat swabs. The magnitude of these differences are unlikely to influence management. Most patients had mild symptoms at 7 days regardless of aetiology, which could inform patients about likely symptom duration.
0263-2136
Little, Paul
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Ordonez-Mena, Jose M
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Fanshawe, Thomas R.
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Butler, Chris
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Mant, David
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Moore, Michael
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Stuart, Beth
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Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Ordonez-Mena, Jose M
44068755-83c7-4c44-9528-8441939dbe70
Fanshawe, Thomas R.
7cb37df5-a324-485c-90bb-6640124e6c48
Butler, Chris
95583b3d-b015-42de-ba2d-10de4ba67707
Mant, David
d2e30212-70ec-48c9-b80a-a45cf4bcc46e
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Stuart, Beth
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Little, Paul, Ordonez-Mena, Jose M, Fanshawe, Thomas R., Butler, Chris, Mant, David, Moore, Michael and Stuart, Beth (2020) Relationship between microbiology of throat swab and clinical course among primary care patients with acute cough: a prospective cohort study. Family Practice, 37 (3). (doi:10.1093/fampra/cmz093).

Record type: Article

Abstract


Background: acute lower respiratory tract infections (ALRTIs) account for most antibiotics prescribed in primary care despite lack of efficacy, partly due to clinician uncertainty about aetiology and patient concerns about illness course. Nucleic acid amplification tests could assist antibiotic targeting.

Methods: in this prospective cohort study, 645 patients presenting to primary care with acute cough and suspected ALRTI, provided throat swabs at baseline. These were tested for respiratory pathogens by real-time Polymerase Chain Reaction and classified as having a respiratory virus, bacteria, both or neither. 354 participants scored the symptoms severity daily for one week in a diary (0=absent to 4=severe problem).

Results: organisms were identified in 346/645 (53.6%) participants. There were differences in the prevalence of seven symptoms between the organism groups at baseline. Those with a virus alone, and those with both virus and bacteria, had higher average severity scores of all symptoms combined during the week of follow-up than those in whom no organisms were detected (adjusted mean differences 0.204 (95% confidence interval 0.010 to 0.398) and 0.348 (0.098 to 0.598) respectively). There were no differences in duration of symptoms rated as moderate or severe between organism groups.

Conclusions: differences in presenting symptoms and symptoms severity can be identified between patients with viruses and bacteria identified on throat swabs. The magnitude of these differences are unlikely to influence management. Most patients had mild symptoms at 7 days regardless of aetiology, which could inform patients about likely symptom duration.

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3CPlus_manuscript_(revised_manuscript_Family_Practice) (clean copy) - Accepted Manuscript
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Accepted/In Press date: 2 December 2019
e-pub ahead of print date: 17 December 2019
Published date: 1 June 2020

Identifiers

Local EPrints ID: 436361
URI: http://eprints.soton.ac.uk/id/eprint/436361
ISSN: 0263-2136
PURE UUID: 69016069-dc77-4452-b041-f2d469d13165
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Beth Stuart: ORCID iD orcid.org/0000-0001-5432-7437

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Date deposited: 09 Dec 2019 17:30
Last modified: 10 Jan 2022 02:51

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Contributors

Author: Paul Little
Author: Jose M Ordonez-Mena
Author: Thomas R. Fanshawe
Author: Chris Butler
Author: David Mant
Author: Michael Moore ORCID iD
Author: Beth Stuart ORCID iD

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