Efficacy and safety of discontinuing antibiotic treatment for uncomplicated respiratory tract infections when deemed unnecessary. A multicentre, randomized clinical trial in primary care

Carlos Llor*, Ana Moragas, Carolina Bayona, Josep M. Cots, Silvia Hernández, Olga Calviño, Migdalia Rodríguez, Marc Miravitlles

*Kontaktforfatter for dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Abstrakt

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.

OriginalsprogEngelsk
TidsskriftClinical Microbiology and Infection
ISSN1198-743X
DOI
StatusE-pub ahead of print - 4. aug. 2021

Bibliografisk note

Funding Information:
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).

Funding Information:
CL reports receiving research grants from Abbott Diagnostics . MM has received speaker fees from AstraZeneca , Boehringer Ingelheim , Chiesi , Cipla , Menarini , Rovi , Bial , Sandoz , Zambon , CSL Behring , Grifols and Novartis , consulting fees from AstraZeneca , Boehringer Ingelheim , Chiesi , GlaxoSmithKline , Bial , Gebro Pharma , CSL Behring , Laboratorios Esteve , Ferrer , Mereo Biopharma , Verona Pharma , Spin Therapeutics , pH Pharma , Novartis , Sanofi and Grifols and research grants from GlaxoSmithKline and Grifols . The other authors declare no competing interests.

Publisher Copyright:
© 2021 The Authors

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