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Antibiotics in acute non-pneumonic lower-respiratory tract infection


Müggler, Simon A; Huber, Lars C (2013). Antibiotics in acute non-pneumonic lower-respiratory tract infection. The Lancet Infectious Diseases, 13(10):833.

Abstract

We read with interest the study by Paul Little and colleagues1 that confirmed the findings of previous smaller studies2 and support the present recommendations that acute bronchitis should not be treated with antibiotics. Because the authors used a threshold of 1% for statistical significance, we wonder why one of the secondary outcomes—that fewer individuals experienced new or worsened symptoms in the amoxicillin group—was interpreted as significant (p=0·043). We think that, according to the methods of the authors, none of the primary or secondary outcomes reached statistical significance, which would further corroborate the authors' conclusions to discourage the use of antibiotics in patients with acute non-pneumonic lower-respiratory tract infection. Moreover, these data emphasise the need to develop strategies to identify which patients with lower-respiratory tract infections need antibiotic treatment and which do not. For example, the use of biomarkers such as procalcitonin has been suggested to provide such a discriminative method,3 and thus it might be interesting to know whether the patients included in the present study had low procalcitonin concentration.

Abstract

We read with interest the study by Paul Little and colleagues1 that confirmed the findings of previous smaller studies2 and support the present recommendations that acute bronchitis should not be treated with antibiotics. Because the authors used a threshold of 1% for statistical significance, we wonder why one of the secondary outcomes—that fewer individuals experienced new or worsened symptoms in the amoxicillin group—was interpreted as significant (p=0·043). We think that, according to the methods of the authors, none of the primary or secondary outcomes reached statistical significance, which would further corroborate the authors' conclusions to discourage the use of antibiotics in patients with acute non-pneumonic lower-respiratory tract infection. Moreover, these data emphasise the need to develop strategies to identify which patients with lower-respiratory tract infections need antibiotic treatment and which do not. For example, the use of biomarkers such as procalcitonin has been suggested to provide such a discriminative method,3 and thus it might be interesting to know whether the patients included in the present study had low procalcitonin concentration.

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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic and Policlinic for Internal Medicine
04 Faculty of Medicine > University Hospital Zurich > Clinic for Pneumology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2013
Deposited On:12 Feb 2014 13:40
Last Modified:05 Apr 2016 17:35
Publisher:The Lancet Publishing Group
ISSN:1473-3099
Publisher DOI:https://doi.org/10.1016/S1473-3099(13)70246-9
PubMed ID:24070558

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