Treating patients not diagnoses: challenging assumptions underlying the investigation and management of LRTI in general practice.
OBJECTIVE
Many clinicians treat patients with a lower respiratory tract infection (LRTI) due to bacterial infection with antibiotics, and regard antibiotic treatment as obligatory for patients with radiographic evidence of pneumonia. The necessity of antibiotic treatment is largely unknown and rarely challenged.


METHODS
Twenty-five general practitioners (GPs) recorded clinical information on 247 adult patients presenting with LRTI. Standard microbiological, susceptibility and serological analysis, and chest radiography was performed for all patients. At 28 days after entry into the study, the GPs took a history and conducted a physical examination again and decided whether or not the patient was fully recovered.


RESULTS
Thirty of 63 patients with cultured pathogenic bacteria were either not treated with antibiotics, or treated with an antibiotic to which the cultured bacterium was non-susceptible. All but one recovered spontaneously, although it took more than 28 days for two patients. The other patient recovered with an additional course of antibiotics. Five patients from this cohort with radiological evidence of pneumonia fully recovered without antibiotic treatment.


CONCLUSIONS
Not all patients with bacterial LRTI and/or pneumonia require antibiotic treatment in order to recover. Managing the patient rather than treating a diagnosis appears safe and effective in general practice.
Hopstaken
Rogier M
RM
Maastricht University, Care and Public Health Research Institute, Department of General Practice, PO Box 616, 6200 MD Maastricht, The Netherlands. rogier.hopstaken@hag.unimaas.nl
Coenen
Samuel
S
Butler
Christopher C
CC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D019468:Disease Management; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005194:Family Practice / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011014:Pneumonia / Q000000981:diagnostic imaging / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy*; D010818:Practice Patterns, Physicians'; D011859:Radiography; D012141:Respiratory Tract Infections / Q000000981:diagnostic imaging / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy*
D000900:Anti-Bacterial Agents