Trial reportThe British journal of general practice : the journal of the Royal College of General Practitioners2014
Amoxicillin for acute lower respiratory tract infection in primary care: subgroup analysis of potential high-risk groups.
Trial report in The British journal of general practice : the journal of the Royal College of General Practitioners, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 26 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 2 syntheses or guidelines pooled it, 42 citations in OpenAlex.
- Pooled it
- Bronchitis (acute).BMJ clinical evidence · 2015Pooled it
- Antibiotics for lower respiratory tract infection in children presenting in primary care in England (ARTIC PC): a double-blind, randomised, placebo-controlled trial.Lancet (London, England) · 2021Trial
- Efficacy and Safety of YJP-40 in Patients with Acute Bronchitis: A Randomized, Double-Blind, Parallel Group Study.Tuberculosis and respiratory diseases · 2025Article
- Predicting adverse outcomes in adults with a community-acquired lower respiratory tract infection: a protocol for the development and validation of two prediction models for (i) all-cause hospitalisation and mortality and (ii) cardiovascular outcomes.Diagnostic and prognostic research · 2023Article
- Antibiotics for lower respiratory tract infection in children presenting in primary care: ARTIC-PC RCT.Health technology assessment (Winchester, England) · 2023Article
- Determinants of the Empiric Use of Antibiotics by General Practitioners in South Africa: Observational, Analytic, Cross-Sectional Study.Antibiotics (Basel, Switzerland) · 2022Article
- The Effect of Amoxicillin in Adult Patients Presenting to Primary Care with Acute Cough Predicted to Have Pneumonia or a Combined Viral-Bacterial Infection.Antibiotics (Basel, Switzerland) · 2021Article
- Parent and Clinician Views of Managing Children with Symptoms of a Lower Respiratory Tract Infection and Their Influence upon Decisions to Take Part in a Placebo-Controlled Randomised Control Trial.Antibiotics (Basel, Switzerland) · 2021Article
- Lower respiratory tract infection in the community: associations between viral aetiology and illness course.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2021Article
- Article
- Article
- A machine learning and network framework to discover new indications for small molecules.PLoS computational biology · 2020Article
- HATRIC: a study ofPilot and feasibility studies · 2019Article
- Aetiology of lower respiratory tract infection in adults in primary care: a prospective study in 11 European countries.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2018Article
- Article
- Amoxicillin for acute lower respiratory tract infection in primary care: subgroup analysis by bacterial and viral aetiology.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2018Article
- Development of a prediction tool for patients presenting with acute cough in primary care: a prognostic study spanning six European countries.The British journal of general practice : the journal of the Royal College of General Practitioners · 2018Article
- Amoxicillin is associated with a lower risk of further antibiotic prescriptions for lower respiratory tract infections in primary care - A database analysis spanning over 30 years.European clinical respiratory journal · 2018Article
- Adverse Effects of Amoxicillin for Acute Lower Respiratory Tract Infection in Primary Care: Secondary and Subgroup Analysis of a Randomised Clinical Trial.Antibiotics (Basel, Switzerland) · 2017Article
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
8 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAntibiotics are of limited overall clinical benefit for uncomplicated lower respiratory tract infection (LRTI) but there is uncertainty about their effectiveness for patients with features associated with higher levels of antibiotic prescribing.
aimTo estimate the benefits and harms of antibiotics for acute LRTI among those producing coloured sputum, smokers, those with fever or prior comorbidities, and longer duration of prior illness. DESIGN AND
settingSecondary analysis of a randomised controlled trial of antibiotic placebo for acute LRTI in primary care.
methodTwo thousand and sixty-one adults with acute LRTI, where pneumonia was not suspected clinically, were given amoxicillin or matching placebo. The duration of symptoms, rated moderately bad or worse (primary outcome), symptom severity on days 2-4 (0-6 scale), and the development of new or worsening symptoms were analysed in pre-specified subgroups of interest. Evidence of differential treatment effectiveness was assessed in prespecified subgroups by interaction terms.
resultsNo subgroups were identified that were significantly more likely to benefit from antibiotics in terms of symptom duration or the development of new or worsening symptoms. Those with a history of significant comorbidities experienced a significantly greater reduction in symptom severity between days 2 and 4 (interaction term -0.28, P = 0.003; estimated effect of antibiotics among those with a past history -0.28 [95% confidence interval = -0.44 to -0.11], P = 0.001), equivalent to three people in 10 rating symptoms as a slight rather than a moderately bad problem. For subgroups not specified in advance antibiotics provided a modest reduction in symptom severity for non-smokers and for those with short prior illness duration (<7 days), and a modest reduction in symptom duration for those with short prior illness duration.
conclusionThere is no clear evidence of clinically meaningful benefit from antibiotics in the studied high-risk groups of patients presenting in general practice with uncomplicated LRTIs where prescribing is highest. Any possible benefit must be balanced against the side-effects and longer-term effects on antibiotic resistance.
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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.