Amoxicillin for acute lower respiratory tract infection in primary care: subgroup analysis of potential high-risk groups

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

“…This is in contrast to retrospective European data where current smoking was an independent risk factor for antibiotic prescription in primary care patients presenting with cough and the increased risk of community acquired pneumonia and death of pneumococcal disease in smokers [14,15]. Yet the cough study demonstrated no improved recovery with antibiotics and subgroup analysis of a multi-centre randomised, placebo-controlled trial of amoxicillin versus placebo in LRTI showed no clinically meaningful advantage of antibiotic treatment, supporting our described UK findings [16]. …”

Can 88% of patients with acute lower respiratory infection all be special?

“…Figure 1 in the Moore article shows the strength of evidence for the lack of effect on duration of 'moderately bad' or worse symptoms. 12 But, we hear you say, my patient is special they need antibiotics because they are a smoker/have green phlegm/a more severe illness/chronic lung disease/ are going on a family holiday tomorrow/ have a vitally important business meeting in Washington DC next week [delete as appropriate]. Moore et al 12 address 'beingspecial' by investigating patient subgroups who might differ from the full group, for whom antibiotics may offer extra benefits (or harms).…”

“…12 But, we hear you say, my patient is special they need antibiotics because they are a smoker/have green phlegm/a more severe illness/chronic lung disease/ are going on a family holiday tomorrow/ have a vitally important business meeting in Washington DC next week [delete as appropriate]. Moore et al 12 address 'beingspecial' by investigating patient subgroups who might differ from the full group, for whom antibiotics may offer extra benefits (or harms). Also referred to as 'looking for interactions', this article reports effects of antibiotics on patient subgroups defined by the presence/absence of factors that are of clinical concern: green phlegm; currently smoking; 'significant past medical history'; longer illness duration prior to consulting; fever at presentation; and 'minor' chest signs (not suggestive of pneumonia).…”

“…The article by Moore et al 12 is a secondary analysis of a previously published randomised controlled trial (RCT). 14 The largest of its kind, 2061 patients were randomised to amoxicillin 1 g or placebo three times daily and asked to complete a validated diary 15 to measure duration and severity of the most common LRTI symptoms.…”

“…However, the rising use of antibiotics and antimicrobial resistance is also of concern, and is now at the top of the Chief Medical Officer (CMO) for England, the Department of Health and the National Institute for Health Research (NIHR) agendas. In March 2013, the CMO highlighted the rise of antimicrobial resistance as a threat to healthcare delivery, 10 12,13 They are both from the humbly named 'GRACE' consortium (www.grace-lrti. org), an internationally respected group of primary care researchers who worked with hundreds of GPs and nurses from 12 European nations to conduct high quality research into LRTI in over 3000 adults.…”