Clinical presentation, microbiological aetiology and disease course in patients with flu-like illness: a post hoc analysis of randomised controlled trial data
Verheij, Theo; Cianci, Daniela; van der Velden, Alike; Butler, Christopher C; Bongard, Emily; Coenen, Samuel; Colliers, Annelies; Francis, Nick; Little, Paul; Godycki-Cwirko, Maciek; Llor, Carl; Chlabicz, Slawomir; Lionis, Christos; Sundvall, Pär-Daniel; Bjerrum, Lars; De Sutter, An; Aabenhus, Rune; Jonassen Harbin, Nicolay; Lindbaek, Morten; Glinz, Dominik; Bucher, Heiner; Kovacs, Bernadett; Seifert, Bohumil; Radzeviciene JUrgute, Ruta; Touboul Lundgren, Pia; de Paor, Muireann; Matheeussen, Veerle; Goossens, Herman; Ieven, Margareta
(2022) The British journal of general practice : the journal of the Royal College of General Practitioners, volume 72, issue 716, pp. e217 - e224
(Article)
Abstract
BACKGROUND: There 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. AIM: To investigate whether clinical presentation and illness course differ between RTIs
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where a viral pathogen was detected and those where a potential bacterial pathogen was found. DESIGN AND SETTING: Post 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. METHOD: Patient 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. RESULTS: Except 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. CONCLUSION: Given 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.
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Keywords: Diagnosis, Oseltamivir, Primary health care, Randomised controlled trial, Respiratory tract infections, Family Practice
ISSN: 0960-1643
Publisher: Royal College of General Practitioners
Note: Funding Information: Christopher C Butler reports grants from the National Institute for Health Research (NIHR) Health as NIHR Senior Investigator, grants from the NIHR Health Technology Assessment Programme to support the study, grants from NIHR Health Protection Research Unit on Health Care Associated Infections and Antimicrobial Resistance, grants from NIHR Health for the MedTech and In Vitro Diagnostics Cooperative for innovative diagnostics and monitoring technology to enhance community health care during the conduct of the study, personal fees from Pfizer and Roche Molecular Systems, and grants from Roche Molecular Diagnostics. Alike W van der Velden reports personal fees from Reckitt Benckiser. Christos Lionis reports grants from Abbott Diagnostics. Heiner C Bucher or his Institute has received, in the 36 months before the submission of this manuscript, grants, support for travelling, consultancy fees, and honoraria from Gilead, Bristol Myers Squibb, ViiV Healthcare, Idorsia, and Roche, outside the submitted work. He serves as the President of the Association Contre le HIV et Autres Infections Transmissibles. In this function he has received support from the Swiss HIV Cohort Study from ViiV Healthcare, Gilead, Bristol Myers Squibb, Merck Sharp & Dohme, and AbbVie. Theo J Verheij reports grants from the NIHR, Netherlands Organization of Health Research and Development, and the EU Innovative Medicines Initiative, which has Janssen Pharmaceuticals, Biocartis, bioMérieux, and Berry Consultants as partners, all outside the submitted work. All other authors have declared no competing interests. Publisher Copyright: © 2022 Royal College of General Practitioners. All rights reserved.
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