1. Efficacy and safety of discontinuing antibiotic treatment for uncomplicated respiratory tract infections when deemed unnecessary. A multicentre, randomized clinical trial in primary care
- Author
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Carolina Bayona, Josep Maria Cots, Silvia Hernández, Migdalia Rodríguez, Carlos Llor, Marc Miravitlles, Olga Calviño, Ana Moragas, Institut Català de la Salut, [Llor C] Department of Public Health, General Practice, University of Southern Denmark, Odense, Denmark. University Institute in Primary Care Research Jordi Gol, Via Roma Health Centre, Barcelona, Spain. [Moragas A] Universitat Rovira i Virgili. Jaume I Health Centre, Tarragona, Spain. [Bayona C, Rodríguez M] Primary Healthcare Centre La Marina, Barcelona, Spain. [Cots JM] Universitat of Barcelona, Primary Healthcare Centre La Marina, Barcelona, Spain. [Hernández S, Calviño O] Primary Healthcare Centre Jaume I, Tarragona, Spain. [Miravitlles M] Servei de Pneumologia, Vall d'Hebron Hospital Universitari, Barcelona, Spain. Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain. CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus
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Adult ,Microbiology (medical) ,medicine.medical_specialty ,infecciones bacterianas y micosis::infección::infecciones del tracto respiratorio [ENFERMEDADES] ,Otros calificadores::Otros calificadores::/farmacoterapia [Otros calificadores] ,Other subheadings::Other subheadings::/drug therapy [Other subheadings] ,law.invention ,Bacterial Infections and Mycoses::Infection::Respiratory Tract Infections [DISEASES] ,Patient satisfaction ,Randomized controlled trial ,law ,Internal medicine ,Sore throat ,medicine ,Humans ,Medicaments antibacterians ,Bronchitis ,Adverse effect ,Respiratory Tract Infections ,Antibacterial agent ,Primary Health Care ,Respiratory tract infections ,business.industry ,Pharyngitis ,General Medicine ,Infeccions respiratòries - Tractament ,Anti-Bacterial Agents ,Discontinuation ,Clinical trial ,Infectious Diseases ,Avaluació de resultats (Assistència sanitària) ,medicine.symptom ,business - Abstract
Antibacterial agent; Antibiotic stewardship; Primary health care Agente antibacteriano; Administración de antibióticos; Atención primaria de salud Agent antibacterià; Administració d'antibiòtics; Atenció primària de salut Objectives To determine the benefits and harms of discontinuing unnecessary antibiotic therapy for uncomplicated respiratory tract infections (RTI) when antibiotics are considered no longer necessary. Methods Multicentre, open-label, randomized controlled clinical trial in primary care centres from 2017 to 2020 (ClinicalTrials.gov, NCT02900820). Adults with RTIs—acute rhinosinusitis, sore throat, influenza or acute bronchitis—who had previously taken any dose of antibiotic for less than 3 days, which physicians no longer deemed necessary were recruited. The patients were randomly assigned in a 1:1 ratio to discontinuing antibiotic therapy or the usual strategy of continuing antibiotic treatment. The primary outcome was the duration of severe symptoms (number of days scoring 5 or 6 on a six-item Likert scale). Secondary outcomes included days with symptoms, moderate symptoms (scores of 3 or 4), antibiotics taken, adverse events, patient satisfaction and complications within the first 3 months. Results A total of 467 patients were randomized, out of which 409 were considered valid for the analysis. The mean (SD) duration of severe symptoms was 3.0 (1.5) days for the patients assigned to discontinuation and 2.8 (1.3) days for those allocated to the control group (mean difference 0.2 days; 95% CI –0.1 to 0.4 days). Patients randomized to the discontinuation group used fewer antibiotics after the baseline visit (52/207 (25.1%) versus 182/202 (90.1%); p 0.001). Patients assigned to antibiotic continuation presented a relative risk of adverse events of 1.47 (95% CI 0.80–2.71), but the need for further health-care contact in the following 3 months was slightly lower (RR 0.61; 95% CI 0.28–1.37). Conclusions Discontinuing antibiotic treatment for uncomplicated RTIs when clinicians consider it unnecessary is safe and notably reduces antibiotic consumption. This work was supported by the Catalan Society of Family Medicine, grant number FAP1601. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. This trial was registered with the ClinicalTrials.gov database (Identifier: NCT02900820).
- Published
- 2022
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