JAC Advance Access originally published online on September 8, 2005
Journal of Antimicrobial Chemotherapy 2005 56(5):941-943; doi:10.1093/jac/dki330
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Treating patients not diagnoses: challenging assumptions underlying the investigation and management of LRTI in general practice
1 Maastricht University, Care and Public Health Research Institute, Department of General Practice, PO Box 616, 6200 MD Maastricht, The Netherlands; 2 Fund for Scientific Research, Flanders, Brussels, Belgium; 3 Department of General Practice, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; 4 Department of General Practice, Cardiff University, Llanedeyrn Health Centre, Llanedeyrn, CF23 9PN, Cardiff, UK
Received 3 June 2005; returned 5 August 2005; revised 10 August 2005; accepted 19 August 2005
* Corresponding author. Tel: +31-433882323; Fax: +31-433619344; E-mail: rogier.hopstaken{at}hag.unimaas.nl
Objectives: Many clinicians treat patients with a lower respiratory tract infection (LRTI) due to bacterial infection with antibiotics, and regard antibiotic treatment as obligatory for patients with radiographic evidence of pneumonia. The necessity of antibiotic treatment is largely unknown and rarely challenged.
Patients and methods: Twenty-five general practitioners (GPs) recorded clinical information on 247 adult patients presenting with LRTI. Standard microbiological, susceptibility and serological analysis, and chest radiography was performed for all patients. At 28 days after entry into the study, the GPs took a history and conducted a physical examination again and decided whether or not the patient was fully recovered.
Results: Thirty of 63 patients with cultured pathogenic bacteria were either not treated with antibiotics, or treated with an antibiotic to which the cultured bacterium was non-susceptible. All but one recovered spontaneously, although it took more than 28 days for two patients. The other patient recovered with an additional course of antibiotics. Five patients from this cohort with radiological evidence of pneumonia fully recovered without antibiotic treatment.
Conclusions: Not all patients with bacterial LRTI and/or pneumonia require antibiotic treatment in order to recover. Managing the patient rather than treating a diagnosis appears safe and effective in general practice.
Keywords: respiratory tract infections , pneumonia , antibiotics , prognosis