Amoxicillin for acute lower respiratory tract infection in primary care : subgroup analysis by bacterial and viral aetiology
| Autor: | R. Bruyndonckx, B. Stuart, P. Little, N. Hens, M. Ieven, C.C. Butler, T. Verheij, H. Goossens, S. Coenen, J. Almirall, C. Brugman, S. Chlabicz, A. De Sutter, M. Davies, M. Godycki-Cwirko, P. Fernandez, I. Hering, K. Hood, G.I.T. Schaberg, A. Torres, A. Kowalczyk, C. Lammens, M. Lemiengre, F. Leus, K. Loens, A. Mierzecki, M. Moore, M. Muras, G. O'Reilly, N.S. Romano, M.S. Prat, J. Swain, R. Veen, T. Worby |
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| Přispěvatelé: | GRACE Project Grp, BRUYNDONCKX, Robin, Stuart, B., Little, P., HENS, Niel, Ieven, Margareta, Butler, C. C., Verheij, T., Goossens, H., Coenen, S. |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
Male Symptom duration Severity of Illness Index Illness deterioration Symptom severity Lower respiratory tract infection 0302 clinical medicine Medicine 030212 general & internal medicine Aetiology Respiratory Tract Infections Coinfection General Medicine Bacterial Infections Anti-Bacterial Agents Europe Treatment Outcome Infectious Diseases Virus Diseases Population Surveillance Acute Disease Disease Progression Female medicine.drug Microbiology (medical) medicine.medical_specialty 030106 microbiology Subgroup analysis macromolecular substances Primary care Article 03 medical and health sciences Internal medicine Acute lower respiratory tract infection Humans Intensive care medicine Biology Proportional Hazards Models Primary Health Care business.industry Amoxicillin medicine.disease Etiology Human medicine business |
| Zdroj: | Clinical microbiology and infection Clinical Microbiology and Infection, 24(8), 871. Elsevier Limited Clinical Microbiology and Infection |
| ISSN: | 1198-743X |
| Popis: | 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. The authors have no conflicts of interest to declare. GRACE was funded by the European Community's Sixth Framework Programme (grant agreement 518226). Work in the UK was also supported by the National Institute for Health Research, in Barcelona by 2009 SGR 911 Ciber de Enfermedades Respiratorias (Ciberes CB06/06/0028), and in Belgium by the Research Foundationd-Flanders (FWO; G.0274.08N). Financial support from the Methusalem financing program of the Flemish Government is also gratefully acknowledged. NH acknowledges support from the University of Antwerp scientific chair in evidence-based vaccinology, financed in 2009-2017 by a gift from Pfizer and GSK. This publication has been financially supported through the European Science Foundation, in the framework of the Research Networking Program TRACE (www.esf.org/trace). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We thank all the clinicians and patients who consented to be part of GRACE, without whom this study would not have been possible. We are grateful to key members of the GRACE project group whose hard work has made this study possible, including Niels Adriaenssens, Jordi Almirall, Curt Brugman, Slawomir Chlabicz, An De Sutter, Mel Davies, Maciek Godycki-Cwirko, Patricia Fernandez, Iris Hering, Kerenza Hood, Greet Ieven Tom Schaberg, Antoni Torres, Anna Kowalczyk, Christine Lammens, Marieke Lemiengre, Frank Leus, Katherine Loens, Artur Mierzecki, Michael Moore, Magdalena Muras, Gilly O'Reilly, Nuria Sanchez Romano, Matteu Serra Prat, Jackie Swain, Robert Veen, and Tricia Worby. |
| Databáze: | OpenAIRE |
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