Amoxicillin for acute lower respiratory tract infection in primary care: subgroup analysis by bacterial and viral aetiology Academic Article uri icon

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abstract

  • 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.

authors

  • Bruyndonckx, R
  • Stuart, B
  • Little, P
  • Hens, N
  • Ieven, M
  • Butler, Christopher
  • Verheij, T
  • Goossens, H
  • Coenen, S
  • Almirall, J
  • Brugman, C
  • Chlabicz, S
  • De Sutter, A
  • Davies, M
  • Godycki-Cwirko, M
  • Fernandez, P
  • Hering, I
  • Hood, K
  • Schaberg, GIT
  • Torres, A
  • Kowalczyk, A
  • Lammens, C
  • Lemiengre, M
  • Leus, F
  • Loens, K
  • Mierzecki, A
  • Moore, M
  • Muras, M
  • O'Reilly, G
  • Romano, NS
  • Prat, MS
  • Swain, J
  • Veen, R
  • Worby, T

publication date

  • August 2018