Abstract
BackgroundThere is little evidence about the relationship between aetiology, illness severity, and clinical course of respiratory tract infections (RTIs) in primary care. Understanding these associations would aid in the development of effective management strategies for these infections.AimTo investigate whether clinical presentation and illness course differ between RTIs where a viral pathogen was detected and those where a potential bacterial pathogen was found.Design and settingPost hoc analysis of data from a pragmatic randomised trial on the effects of oseltamivir in patients with flu-like illness in primary care (n = 3266) in 15 European countries.MethodPatient characteristics and their signs and symptoms of disease were registered at baseline. Nasopharyngeal (adults) or nasal and pharyngeal (children) swabs were taken for polymerase chain reaction analysis. Patients were followed up until 28 days after inclusion. Regression models and Kaplan–Meier curves were used to analyse the relationship between aetiology, clinical presentation at baseline, and course of disease including complications.ResultsExcept for a less prominent congested nose (odds ratio [OR] 0.55, 95% confidence interval [CI] = 0.35 to 0.86) and acute cough (OR 0.42, 95% CI = 0.27 to 0.65) in patients with flu-like illness in whom a possible bacterial pathogen was isolated, there were no clear clinical differences in presentations between those with a possible bacterial aetiology compared with those with a viral aetiology. Also, course of disease and complications were not related to aetiology.ConclusionGiven current available microbiological tests and antimicrobial treatments, and outside pandemics such as COVID-19, microbiological testing in primary care patients with flu-like illness seems to have limited value. A wait-and-see policy in most of these patients with flu-like illness seems the best option.
Highlights
Evidence-based antibiotic use reduces an important driver of antimicrobial resistance and unnecessary exposure to side-effects, and leads to better resource utilisation
Both GPs and patients still assume that a distinction between viral and bacterial infections is important for illness prognosis and treatment decisions
The results show that there were no meaningful differences in illness severity at presentation and course of disease between patients in whom viral, bacterial or mixed pathogens were found
Summary
Evidence-based antibiotic use reduces an important driver of antimicrobial resistance and unnecessary exposure to side-effects, and leads to better resource utilisation. The need for point of care tests to distinguish between bacterial and viral infections in primary care is felt by many and the focus of several studies.(3)(4)(5) there is a paucity of evidence about the relationship between aetiology, illness severity and clinical course of RTI in primary care. It is important to study the relation between presentation and course of disease and microbiological aetiology, to support the development of relevant diagnostic and therapeutic strategies of common RTI in primary care. There is little evidence about the relation between aetiology, illness severity and clinical course of respiratory tract infections (RTI) in primary care Understanding these associations would aid to develop effective management strategies for these infections
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