Evidence map›Paper›PMID 29108950›Full record

ArticleClinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases2018

Amoxicillin for acute lower respiratory tract infection in primary care: subgroup analysis by bacterial and viral aetiology.

R Bruyndonckx, B Stuart, P Little, N Hens, M Ieven, C C Butler, T Verheij, H Goossens, S Coenen, GRACE project group

Open access · bronzeAbstract readMulticenter Study

PubMed Full text at PMC Publisher

In one paragraph

Article in Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it

0cells of the map it votes in

12citing papers in PubMed, 1 pooled it

1.7field-weighted citation impact, top 14% of its field

1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 1 synthesis or guideline pooled it, 24 citations in OpenAlex.

Delayed antibiotic prescribing for respiratory tract infections: individual patient data meta-analysis.BMJ (Clinical research ed.) · 2021
Pooled it
Antibiotic effectiveness for children with lower respiratory infections: prospective cohort and trial in primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2023
Trial
Clinical presentation, microbiological aetiology and disease course in patients with flu-like illness: a post hoc analysis of randomised controlled trial data.The British journal of general practice : the journal of the Royal College of General Practitioners · 2022
Trial
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) · 2021
Trial
Antibiotics for lower respiratory tract infection in children presenting in primary care: ARTIC-PC RCT.Health technology assessment (Winchester, England) · 2023
Article
Using microbiological data to improve the use of antibiotics for respiratory tract infections: A protocol for an individual patient data meta-analysis.PloS one · 2023
Article
Nationwide implementation of online communication skills training to reduce overprescribing of antibiotics: a stepped-wedge cluster randomized trial in general practice.JAC-antimicrobial resistance · 2022
Article
Antibiotic Prescriptions for Respiratory Tract Viral Infections in the Colombian Population.Antibiotics (Basel, Switzerland) · 2021
Article
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) · 2021
Article
The Clinical Diagnostic Values of SAA, PCT, CRP, and IL-6 in Children with Bacterial, Viral, or Co-Infections.International journal of general medicine · 2021
Article
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 · 2021
Article
Signs and symptoms do not predict, but may help rule out acute Q fever in favour of other respiratory tract infections, and reduce antibiotics overuse in primary care.BMC infectious diseases · 2020
Article

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 1 institution in 5 countries.

R BruyndonckxInteruniversity Institute for Biostatistics and Statistical Bioinformatics (iBIOSTAT), Hasselt University, Hasselt, Belgium; Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium; Aldermoor Health Centre, University of Southampton, Southampton, UK; Centre for Health Economic Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK; Julius Centre for Health, Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium; Department of Epidemiology and Social Medicine (ESOC), University of Antwerp, Antwerp, Belgium. Electronic address: robin.bruyndonckx@uhasselt.be.

B StuartInteruniversity Institute for Biostatistics and Statistical Bioinformatics (iBIOSTAT), Hasselt University, Hasselt, Belgium; Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium; Aldermoor Health Centre, University of Southampton, Southampton, UK; Centre for Health Economic Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK; Julius Centre for Health, Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium; Department of Epidemiology and Social Medicine (ESOC), University of Antwerp, Antwerp, Belgium.

P LittleInteruniversity Institute for Biostatistics and Statistical Bioinformatics (iBIOSTAT), Hasselt University, Hasselt, Belgium; Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium; Aldermoor Health Centre, University of Southampton, Southampton, UK; Centre for Health Economic Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK; Julius Centre for Health, Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium; Department of Epidemiology and Social Medicine (ESOC), University of Antwerp, Antwerp, Belgium.

N HensInteruniversity Institute for Biostatistics and Statistical Bioinformatics (iBIOSTAT), Hasselt University, Hasselt, Belgium; Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium; Aldermoor Health Centre, University of Southampton, Southampton, UK; Centre for Health Economic Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK; Julius Centre for Health, Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium; Department of Epidemiology and Social Medicine (ESOC), University of Antwerp, Antwerp, Belgium.

M IevenInteruniversity Institute for Biostatistics and Statistical Bioinformatics (iBIOSTAT), Hasselt University, Hasselt, Belgium; Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium; Aldermoor Health Centre, University of Southampton, Southampton, UK; Centre for Health Economic Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK; Julius Centre for Health, Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium; Department of Epidemiology and Social Medicine (ESOC), University of Antwerp, Antwerp, Belgium.

C C ButlerInteruniversity Institute for Biostatistics and Statistical Bioinformatics (iBIOSTAT), Hasselt University, Hasselt, Belgium; Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium; Aldermoor Health Centre, University of Southampton, Southampton, UK; Centre for Health Economic Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK; Julius Centre for Health, Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium; Department of Epidemiology and Social Medicine (ESOC), University of Antwerp, Antwerp, Belgium.

T VerheijInteruniversity Institute for Biostatistics and Statistical Bioinformatics (iBIOSTAT), Hasselt University, Hasselt, Belgium; Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium; Aldermoor Health Centre, University of Southampton, Southampton, UK; Centre for Health Economic Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK; Julius Centre for Health, Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium; Department of Epidemiology and Social Medicine (ESOC), University of Antwerp, Antwerp, Belgium.

H GoossensInteruniversity Institute for Biostatistics and Statistical Bioinformatics (iBIOSTAT), Hasselt University, Hasselt, Belgium; Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium; Aldermoor Health Centre, University of Southampton, Southampton, UK; Centre for Health Economic Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK; Julius Centre for Health, Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium; Department of Epidemiology and Social Medicine (ESOC), University of Antwerp, Antwerp, Belgium.

S CoenenInteruniversity Institute for Biostatistics and Statistical Bioinformatics (iBIOSTAT), Hasselt University, Hasselt, Belgium; Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium; Aldermoor Health Centre, University of Southampton, Southampton, UK; Centre for Health Economic Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK; Julius Centre for Health, Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium; Department of Epidemiology and Social Medicine (ESOC), University of Antwerp, Antwerp, Belgium.

GRACE project groupInteruniversity Institute for Biostatistics and Statistical Bioinformatics (iBIOSTAT), Hasselt University, Hasselt, Belgium; Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium; Aldermoor Health Centre, University of Southampton, Southampton, UK; Centre for Health Economic Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK; Julius Centre for Health, Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium; Department of Epidemiology and Social Medicine (ESOC), University of Antwerp, Antwerp, Belgium.

University of Antwerp · BE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveWe 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.

methodsThis 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.

results2058 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).

conclusionsAmoxicillin 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.

Indexed as

Primary Health CareAcute DiseaseAmoxicillinAnti-Bacterial AgentsBacterial InfectionsCoinfectionDisease ProgressionEuropeFemaleHumansMalePopulation SurveillanceProportional Hazards ModelsRespiratory Tract InfectionsSeverity of Illness IndexTreatment OutcomeAmoxicillinAnti-Bacterial AgentsAetiologyAmoxicillinIllness deteriorationLower respiratory tract infectionSymptom durationSymptom severity

Identifiers

PMID29108950

DOI10.1016/j.cmi.2017.10.032

PMCPMC7128813

OpenAlexW2766627780

What OpenQuestion holds

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Registered trials

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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.