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JAC Advance Access published online on September 8, 2005
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dki330
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Received June 3, 2005
Revised August 10, 2005
Accepted August 19, 2005

Brief report

Treating patients not diagnoses: challenging assumptions underlying the investigation and management of LRTI in general practice

Rogier M. Hopstaken 1*, Samuel Coenen 2, and Christopher C. Butler 3

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; Department of General Practice, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
3 Department of General Practice, Cardiff University, Llanedeyrn Health Centre, Llanedeyrn, CF23 9PN, Cardiff, UK

* To whom correspondence should be addressed.
Rogier M. Hopstaken, E-mail: rogier.hopstaken{at}hag.unimaas.nl


  Abstract

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.
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