ArticleBMC medicine2011
A decision aid to rule out pneumonia and reduce unnecessary prescriptions of antibiotics in primary care patients with cough and fever.
Article in BMC medicine, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 3 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
26 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Clinical features for diagnosis of pneumonia among adults in primary care setting: A systematic and meta-review.Scientific reports · 2019Pooled it
- Pooled it
- Signs and Symptoms That Rule out Community-Acquired Pneumonia in Outpatient Adults: A Systematic Review and Meta-Analysis.Journal of the American Board of Family Medicine : JABFMPooled it
- Using a decision support tool to reduce inappropriate antibiotic use after a delayed prescription.Applied psychology. Health and well-being · 2026Trial
- Usefulness of C-reactive protein testing in acute cough/respiratory tract infection: an open cluster-randomized clinical trial with C-reactive protein testing in the intervention group.BMC family practice · 2014Trial
- External validation of risk scores and multivariate models for the diagnosis of community-acquired pneumonia in outpatients.The European journal of general practice · 2026Article
- Effect of a multifaceted intervention on potentially unnecessary antibiotic prescriptions in general practice, out-of-hours services, and nursing homes in Spain.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2025Article
- C-reactive protein point-of-care testing in primary care-broader implementation needed to combat antimicrobial resistance.Frontiers in public health · 2024Review
- Antibiotic Treatment for Lower Respiratory Tract Infections in Primary Care: A Register-Based Study Examining the Role of Radiographic Imaging.Antibiotics (Basel, Switzerland) · 2023Article
- Guidance on C-reactive protein point-of-care testing and complementary strategies to improve antibiotic prescribing for adults with lower respiratory tract infections in primary care.Frontiers in medicine · 2023Article
- C-reactive protein point-of-care testing and complementary strategies to improve antibiotic stewardship in children with acute respiratory infections in primary care.Frontiers in pediatrics · 2023Article
- Community-acquired pneumonia - use of chest x-rays for diagnosis in family practice.BMC primary care · 2022Article
- Use of chest X-ray in the assessment of community acquired pneumonia in primary care - an intervention study.Scandinavian journal of primary health care · 2020Article
- Change in the use of diagnostic tests in the management of lower respiratory tract infections: a register-based study in primary care.BJGP open · 2020Article
- Review
- The Spectrum of Non-asthmatic Airway Diseases Contributing to Cough in the Adult.Current otorhinolaryngology reports · 2019Review
- Outpatient Antibiotic Stewardship: A Growing Frontier-Combining Myxovirus Resistance Protein A With Other Biomarkers to Improve Antibiotic Use.Open forum infectious diseases · 2018Article
- Diagnostic Accuracy of FebriDx: A Rapid Test to Detect Immune Responses to Viral and Bacterial Upper Respiratory Infections.Journal of clinical medicine · 2017Article
- Proposed Clinical Decision Rules to Diagnose Acute Rhinosinusitis Among Adults in Primary Care.Annals of family medicine · 2017Article
- The added value of C-reactive protein measurement in diagnosing pneumonia in primary care: a meta-analysis of individual patient data.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2017Article
Corrections and comments
- Commented on by[Not Available].2013
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPhysicians fear missing cases of pneumonia and treat many patients with signs of respiratory infection unnecessarily with antibiotics. This is an avoidable cause for the increasing worldwide problem of antibiotic resistance. We developed a user-friendly decision aid to rule out pneumonia and thus reduce the rate of needless prescriptions of antibiotics.
methodsThis was a prospective cohort study in which we enrolled patients older than 18 years with a new or worsened cough and fever without serious co-morbidities. Physicians recorded results of a standardized medical history and physical examination. C-reactive protein was measured and chest radiographs were obtained. We used Classification and Regression Trees to derive the decision tool.
resultsA total of 621 consenting eligible patients were studied, 598 were attending a primary care facility, were 48 years on average and 50% were male. Radiographic signs for pneumonia were present in 127 (20.5%) of patients. Antibiotics were prescribed to 234 (48.3%) of patients without pneumonia. In patients with C-reactive protein values below 10 μg/ml or patients presenting with C-reactive protein between 11 and 50 μg/ml, but without dyspnoea and daily fever, pneumonia can be ruled out. By applying this rule in clinical practice antibiotic prescription could be reduced by 9.1% (95% confidence interval (CI): 6.4 to 11.8).
conclusionsFollowing validation and confirmation in new patient samples, this tool could help rule out pneumonia and be used to reduce unnecessary antibiotic prescriptions in patients presenting with cough and fever in primary care. The algorithm might be especially useful in those instances where taking a medical history and physical examination alone are inconclusive for ruling out pneumonia.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.