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Relationship between microbiology of throat swab and clinical course among primary care patients with acute cough: a prospective cohort study

Research output: Contribution to journalArticle

  • José M. Ordóñez-Mena
  • Thomas R Fanshawe
  • Chris C. Butler
  • David Mant
  • Denise Longhurst
  • Peter Muir
  • Barry Vipond
  • Paul Little
  • Michael Moore
  • Beth Stuart
  • Alastair D Hayhttp://orcid.org/0000-0003-3012-375X
  • Hannah V Thornton
  • Matthew J. Thompson
  • Sue Smith
  • Ann Van den Bruel
  • Victoria Hardy
  • LaiKin Cheah
  • Derrick W Crook
  • Kyle Knox
Original languageEnglish
Article numbercmz093
Number of pages8
JournalFamily Practice
DOIs
DateAccepted/In press - 2 Dec 2019
DatePublished (current) - 17 Dec 2019

Abstract

Background
Acute lower respiratory tract infections (ALRTIs) account for most antibiotics prescribed in primary care despite lack of efficacy, partly due to clinician uncertainty about aetiology and patient concerns about illness course. Nucleic acid amplification tests could assist antibiotic targeting.

Methods
In this prospective cohort study, 645 patients presenting to primary care with acute cough and suspected ALRTI, provided throat swabs at baseline. These were tested for respiratory pathogens by real-time polymerase chain reaction and classified as having a respiratory virus, bacteria, both or neither. Three hundred fifty-four participants scored the symptoms severity daily for 1 week in a diary (0 = absent to 4 = severe problem).

Results
Organisms were identified in 346/645 (53.6%) participants. There were differences in the prevalence of seven symptoms between the organism groups at baseline. Those with a virus alone, and those with both virus and bacteria, had higher average severity scores of all symptoms combined during the week of follow-up than those in whom no organisms were detected [adjusted mean differences 0.204 (95% confidence interval 0.010 to 0.398) and 0.348 (0.098 to 0.598), respectively]. There were no differences in the duration of symptoms rated as moderate or severe between organism groups.

Conclusions
Differences in presenting symptoms and symptoms severity can be identified between patients with viruses and bacteria identified on throat swabs. The magnitude of these differences is unlikely to influence management. Most patients had mild symptoms at 7 days regardless of aetiology, which could inform patients about likely symptom duration.

    Research areas

  • Bacterial, Diagnosis, Infection, Microbiology, Symptoms, Viral

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    Rights statement: This is the final published version of the article (version of record). It first appeared online via Oxford University Press at https://academic.oup.com/fampra/advance-article/doi/10.1093/fampra/cmz093/5679613. Please refer to any applicable terms of use of the publisher.

    Final published version, 204 KB, PDF document

    Licence: CC BY-NC-ND

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