Jolien Teepe1, Berna D L Broekhuizen2, Katherine Loens3, Christine Lammens3, Margareta Ieven3, Herman Goossens3, Paul Little4, Christopher C Butler5,6, Samuel Coenen3,7, Maciek Godycki-Cwirko8, Theo Verheij2. 1. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands j.teepe-2@umcutrecht.nl. 2. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands. 3. University of Antwerp, Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), Antwerp, Belgium. 4. University of Southampton Medical School, Primary Care Medical Group, Southampton, United Kingdom. 5. Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, United Kingdom. 6. Cwm Taf University Health Board, Abercynon, United Kingdom. 7. University of Antwerp, Centre for General Practice, Department of Primary and Interdisciplinary Care (ELIZA), Antwerp, Belgium. 8. Faculty of Health Sciences, Medical University of Lodz, Lodz, Poland.
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.
RCT Entities:
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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Authors: R M Hopstaken; E E Stobberingh; J A Knottnerus; J W M Muris; P Nelemans; P E L M Rinkens; G J Dinant Journal: J Clin Epidemiol Date: 2005-02 Impact factor: 6.437
Authors: Annemiek E Akkerman; Johannes C van der Wouden; Marijke M Kuyvenhoven; Jeanne P Dieleman; Theo J M Verheij Journal: J Antimicrob Chemother Date: 2004-11-16 Impact factor: 5.790
Authors: Saskia F van Vugt; Berna D L Broekhuizen; Christine Lammens; Nicolaas P A Zuithoff; Pim A de Jong; Samuel Coenen; Margareta Ieven; Chris C Butler; Herman Goossens; Paul Little; Theo J M Verheij Journal: BMJ Date: 2013-04-30