Clinical relevance of bacterial resistance in lower respiratory tract infection in primary care: secondary analysis of a multicentre European trial

• Published in: British journal of general practice Vol. 68; no. 674; pp. e627 - e632
• Main Authors: Teepe, Jolien, Broekhuizen, Berna Dl, Goossens, Herman, Hordijk, Patricia Marinka, Loens, Katherine, Lammens, Christine, Ieven, Margareta, Little, Paul, Butler, Chris C, Coenen, Samuel, Godycki-Cwirko, Maciek, Henriques-Normark, Birgitta, Verheij, Theo Jm
• Format: Journal Article
• Language: English
• Published: England Royal College of General Practitioners 01.09.2018
• Subjects: Acute Disease; Adult; Aged; Amoxicillin - pharmacology; Amoxicillin - therapeutic use; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotics; Bacteria; Bacterial infections; Cough - drug therapy; Cough - microbiology; Drug Resistance, Bacterial - drug effects; Female; Humans; Impact analysis; Male; Medicin och hälsovetenskap; Microbial Sensitivity Tests; Middle Aged; Penicillin; Placebos; Primary care; Primary Health Care; Respiratory Tract Infections - drug therapy; Respiratory Tract Infections - microbiology; Respiratory Tract Infections - physiopathology; Streptococcus infections; Treatment Outcome; antimicrobial drug resistance; primary care; cough; prognosis; lower respiratory tract infection
• ISSN: 0960-1643; 1478-5242; 1478-5242
• DOI: 10.3399/bjgp18X698333

The impact of antimicrobial resistance on clinical outcomes in patients with lower respiratory tract infection in primary care is largely unknown. To determine the illness course of infections with resistant bacteria in adults presenting to primary care with acute cough. Secondary analysis of a multicentre European trial in primary care. A total of 2061 adults with acute cough (lasting ≤28 days) were recruited from primary care and randomised to amoxicillin or placebo. To reflect the natural course of disease, only patients in the placebo group ( = 1021) were eligible. Nasopharyngeal flocked swabs and/or sputa (when available) were analysed at baseline and and isolates underwent susceptibility testing. Patients recorded their symptoms in a diary every day for 4 weeks. Patients with and without resistant bacterial infection were compared with regards to symptom severity, duration of symptoms, worsening of illness, and duration of interference with normal activities or work. Of the 834 patients with diary records, 104 showed and/or infection. Of this number, 54 (52%) were resistant to antibiotics, while seven (7%) were resistant to penicillin. For the duration of symptoms rated 'moderately bad or worse' (hazard ratio 1.27, 95% confidence interval [CI] = 0.67 to 2.44), mean symptom severity (difference -0.48, 95% CI = -1.17 to 0.21), and worsening of illness (odds ratio 0.31, 95% CI = 0.07 to 1.41), there was no statistically significant difference between the antibiotic-resistant and antibiotic-sensitive groups. The illness course of antibiotic-resistant lower respiratory tract infection does not differ from that caused by antibiotic-sensitive bacteria.