title: Disease Course of Lower Respiratory Tract Infection With a Bacterial Cause.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands j.teepe-2@umcutrecht.nl.
authors.forename: Jolien
authors.initials: J
authors.lastname: Teepe
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Berna D L
authors.initials: BD
authors.lastname: Broekhuizen
authors.affiliation: University of Antwerp, Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), Antwerp, Belgium.
authors.forename: Katherine
authors.initials: K
authors.lastname: Loens
authors.affiliation: University of Antwerp, Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), Antwerp, Belgium.
authors.forename: Christine
authors.initials: C
authors.lastname: Lammens
authors.affiliation: University of Antwerp, Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), Antwerp, Belgium.
authors.forename: Margareta
authors.initials: M
authors.lastname: Ieven
authors.affiliation: University of Antwerp, Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), Antwerp, Belgium.
authors.forename: Herman
authors.initials: H
authors.lastname: Goossens
authors.affiliation: University of Southampton Medical School, Primary Care Medical Group, Southampton, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.affiliation: Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, United Kingdom.|Cwm Taf University Health Board, Abercynon, United Kingdom.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Butler
authors.affiliation: University of Antwerp, Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), Antwerp, Belgium.|University of Antwerp, Centre for General Practice, Department of Primary and Interdisciplinary Care (ELIZA), Antwerp, Belgium.
authors.forename: Samuel
authors.initials: S
authors.lastname: Coenen
authors.affiliation: Faculty of Health Sciences, Medical University of Lodz, Lodz, Poland.
authors.forename: Maciek
authors.initials: M
authors.lastname: Godycki-Cwirko
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Theo
authors.initials: T
authors.lastname: Verheij
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology*; D015897:Comorbidity; D003371:Cough / Q000188:drug therapy / Q000209:etiology; D018450:Disease Progression; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D013902:Radiography, Thoracic; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D013183:Sputum / Q000382:microbiology; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D000658:Amoxicillin
keywords: bacteria; cough; infection; lower respiratory tract infections; primary health care; prognosis; randomized clinical trial