Treatment of acute cough/lower respiratory tract infection by antibiotic class and associated outcomes: a 13 European country observational study in primary care.
OBJECTIVE
Acute cough/lower respiratory tract infection (LRTI) is one of the commonest reasons for consulting and antibiotic prescribing. There are theoretical reasons why treatment with particular antibiotic classes may aid recovery more than others, but empirical, pragmatic evidence is lacking. We investigated whether treatment with a particular antibiotic class (amoxicillin) was more strongly associated with symptom score resolution and time to patients reporting recovery than each of eight other antibiotic classes or no antibiotic treatment for acute cough/LRTI.


METHODS
Clinicians recorded history, examination findings, symptom severity and antibiotic treatment for 3402 patients in a 13 country prospective observational study of adults presenting in 14 primary care research networks with acute cough/LRTI. 2714 patients completed a symptom score daily for up to 28 days and recorded the day on which they felt recovered. A three-level autoregressive moving average model (1,1) model investigated logged daily symptom scores to analyse symptom resolution. A two-level survival model analysed time to reported recovery. Clinical presentation was controlled for using clinician-recorded symptoms, sputum colour, temperature, age, co-morbidities, smoking status and duration of illness prior to consultation.


RESULTS
Compared with amoxicillin, no antibiotic class (and no antibiotic treatment) was associated with clinically relevant improved symptom resolution (all coefficients in the range -0.02 to 0.01 and all P values greater than 0.12). No antibiotic class (and no antibiotic treatment) was associated with faster time to recovery than amoxicillin.


CONCLUSIONS
Treatment by antibiotic class was not associated with symptom resolution or time to recovery in adults presenting to primary care with acute cough/LRTI.
Butler
Christopher C
CC
Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK.
Hood
Kerenza
K
Kelly
Mark J
MJ
Goossens
Herman
H
Verheij
Theo
T
Little
Paul
P
Melbye
Hasse
H
Torres
Antoni
A
Mölstad
Sigvard
S
Godycki-Cwirko
Maciek
M
Almirall
Jordi
J
Blasi
Francesco
F
Schaberg
Tom
T
Edwards
Peter
P
Rautakorpi
Ulla-Maija
UM
Hupkova
Helena
H
Wood
Joseph
J
Nuttall
Jacqui
J
Coenen
Samuel
S
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003371:Cough / Q000188:drug therapy*; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents