PT  - JOURNAL ARTICLE
AU  - Jolien Teepe
AU  - Berna D. L. Broekhuizen
AU  - Katherine Loens
AU  - Christine Lammens
AU  - Margareta Ieven
AU  - Herman Goossens
AU  - Paul Little
AU  - Christopher C. Butler
AU  - Samuel Coenen
AU  - Maciek Godycki-Cwirko
AU  - Theo Verheij
TI  - Disease Course of Lower Respiratory Tract Infection With a Bacterial Cause
AID  - 10.1370/afm.1974
DP  - 2016 Nov 01
TA  - The Annals of Family Medicine
PG  - 534--539
VI  - 14
IP  - 6
4099  - http://www.annfammed.org/content/14/6/534.short
4100  - http://www.annfammed.org/content/14/6/534.full
SO  - Ann Fam Med2016 Nov 01; 14
AB  - PURPOSE Bacterial pathogens are assumed to cause an illness course different from that of nonbacterial causes of acute cough, but evidence is lacking. We evaluated the disease course of lower respiratory tract infection (LRTI) with a bacterial cause in adults with acute cough.METHODS We conducted a secondary analysis of a multicenter European trial in which 2,061 adults with acute cough (28 days’ duration or less) were recruited from primary care and randomized to amoxicillin or placebo. For this analysis only patients in the placebo group (n = 1,021) were included, reflecting the natural course of disease. Standardized microbiological and serological analyses were performed at baseline to define a bacterial cause. All patients recorded symptoms in a diary for 4 weeks. The disease course between those with and without a bacterial cause was compared by symptom severity in days 2 to 4, duration of symptoms rated moderately bad or worse, and a return consultation.RESULTS Of 1,021 eligible patients, 187 were excluded for missing diary records, leaving 834 patients, of whom 162 had bacterial LRTI. Patients with bacterial LRTI had worse symptoms at day 2 to 4 after the first office visit (P = .014) and returned more often for a second consultation, 27% vs 17%, than those without bacterial LRTI (P = .004). Resolution of symptoms rated moderately bad or worse did not differ (P = .375).CONCLUSIONS Patients with acute bacterial LRTI have a slightly worse course of disease when compared with those without an identified bacterial cause, but the relevance of this difference is not meaningful.